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NPI Code Detail

MEDICARE: MRS. MICHELLE P RISTAU PT

MEDICARE: MRS. MICHELLE P RISTAU 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
1225100000XPhysical Therapist10704024WI

General Provider Information

NPI Number : 1649367244
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE P RISTAU PT
Provider Business Mailing Address
First Line : 2455 N 124TH ST
Second Line :
City : BROOKFIELD
State : WI
Zip : 53005-4630
Country : US
Telephone Number : 414-294-8682
Fax Number : 414-755-1829
Provider Business Practice Location Address
First Line : 2455 N 124TH ST
Second Line :
City : BROOKFIELD
State : WI
Zip : 53005-4630
Country : US
Telephone Number : 414-294-8682
Fax Number : 414-755-1829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 10/14/2012

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Directions to “ MRS. MICHELLE P RISTAU PT” Practice Location

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