Healthcare Provider Details

I. General information

NPI: 1346312220
Provider Name (Legal Business Name): LISA JEAN VANDER GEETEN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N LAKE DR
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

7844 MILWAUKEE AVE
WAUWATOSA WI
53213-2102
US

V. Phone/Fax

Practice location:
  • Phone: 414-292-1057
  • Fax: 414-291-1808
Mailing address:
  • Phone: 414-778-1954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2533-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: