Healthcare Provider Details

I. General information

NPI: 1104616069
Provider Name (Legal Business Name): CASSANDRA POEHLER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 AMERICAN AVE
WAUKESHA WI
53188-5031
US

IV. Provider business mailing address

1230 LINKS CT APT 1
BROOKFIELD WI
53005-6929
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-8830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17300-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: