Healthcare Provider Details

I. General information

NPI: 1649363524
Provider Name (Legal Business Name): SEAN P PASCHKE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16985 W BLUEMOUND RD
BROOKFIELD WI
53005-5909
US

IV. Provider business mailing address

1553 MILWAUKEE ST
DELAFIELD WI
53018-1905
US

V. Phone/Fax

Practice location:
  • Phone: 262-821-4460
  • Fax: 262-821-4464
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3743024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: