Provider Demographics
NPI:1174783245
Name:TUMA, CORRINA JOLINDA (PTA)
Entity type:Individual
Prefix:MRS
First Name:CORRINA
Middle Name:JOLINDA
Last Name:TUMA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:CORRINA
Other - Middle Name:JOLINDA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1436 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166
Mailing Address - Country:US
Mailing Address - Phone:715-526-6111
Mailing Address - Fax:715-524-5708
Practice Address - Street 1:1436 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166
Practice Address - Country:US
Practice Address - Phone:715-526-6111
Practice Address - Fax:715-524-5708
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant