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General NPI Number Information
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NPI Number | 1528346897
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Entity Type | Individual
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Provider Name | SHANNON M TALATZKO DPT
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Gender | Female
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 146 E GENEVA SQ EAST SIDE BLDG
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City | LAKE GENEVA
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State | WI
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Zip | 53147-9694
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Country | US
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Telephone | 414-647-6280
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Fax |
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Provider Business Mailing Address
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Address Line | W165S7431 BELLVIEW DR
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City | MUSKEGO
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State | WI
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Zip | 53150-8840
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Country | US
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Telephone | 414-412-5370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11732-024
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License Number State | WI
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