Healthcare Provider Details

I. General information

NPI: 1194856401
Provider Name (Legal Business Name): LISA ANNE SHELDON DPT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

IV. Provider business mailing address

W51N209 FILLMORE AVE
CEDARBURG WI
53012-2939
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-7465
  • Fax:
Mailing address:
  • Phone: 262-376-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9929-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: