Healthcare Provider Details

I. General information

NPI: 1174216204
Provider Name (Legal Business Name): CLARA BLISKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 DAKOTA DR
GRAFTON WI
53024-9477
US

IV. Provider business mailing address

164 E CHATEAU PL
MILWAUKEE WI
53217-5816
US

V. Phone/Fax

Practice location:
  • Phone: 262-376-2085
  • Fax:
Mailing address:
  • Phone: 608-234-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: