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NPI Code Detail

MEDICARE: DR. JEFFREY P SISCHO DPT, LAT, PT

MEDICARE: DR. JEFFREY P SISCHO DPT, LAT, PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer137-039WI
2225100000XPhysical Therapist10699-024WI

General Provider Information

NPI Number : 1588657902
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY P SISCHO DPT, LAT, PT
Provider Business Mailing Address
First Line : 3121 E DIANE DR
Second Line :
City : OAK CREEK
State : WI
Zip : 53154-3483
Country : US
Telephone Number : 414-570-1450
Fax Number :
Provider Business Practice Location Address
First Line : 100 N EAST AVE
Second Line : PT BUILDING, #116
City : WAUKESHA
State : WI
Zip : 53186-3103
Country : US
Telephone Number : 262-951-3049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 11/29/2016

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