Provider Demographics
NPI:1902112949
Name:PELNER, ANNA RAE (PTA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:RAE
Last Name:PELNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:RAE
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:W6423 LITTLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-9402
Mailing Address - Country:US
Mailing Address - Phone:920-606-9662
Mailing Address - Fax:
Practice Address - Street 1:903 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-1619
Practice Address - Country:US
Practice Address - Phone:715-854-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1638-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant