Individual
MRS. NICHOLE SHANNON BLIESNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2448 S 102ND ST, STE. 340, MILWAUKEE, WI 53227-2466
(414) 329-2428
Mailing address
1434 BLAINE AVE, RACINE, WI 53405-3310
(262) 681-4802
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1561-19
WI
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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