Healthcare Provider Details

I. General information

NPI: 1457214264
Provider Name (Legal Business Name): EMILY MOHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 SPRING ST
MOUNT PLEASANT WI
53405-1667
US

IV. Provider business mailing address

1050 58TH CT APT 202
KENOSHA WI
53144-2434
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-5300
  • Fax:
Mailing address:
  • Phone: 262-818-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: