Healthcare Provider Details

I. General information

NPI: 1346452687
Provider Name (Legal Business Name): PATRICIA ANN SEXSON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MICHIGAN ST
MILWAUKEE WI
53203-2903
US

IV. Provider business mailing address

500 S EDWARDS BLVD UNIT 65
LAKE GENEVA WI
53147-4561
US

V. Phone/Fax

Practice location:
  • Phone: 262-728-5918
  • Fax:
Mailing address:
  • Phone: 262-203-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1279-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: