MEDICARE: SHEREE TODT

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
1	225200000X	Physical Therapy Assistant	507-19	WI

General Provider Information

NPI Number	:	1962508036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEREE TODT

Provider Business Mailing Address
First Line	:	1128 SAINT AGNES DR
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-2258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 PINE BEACH RD
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143-4227
Country	:	US
Telephone Number	:	715-735-6222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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Directions to “ SHEREE TODT ” Practice Location

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