Individual
SHALLIN ROSE NIEMYJSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
211 S CURTIS ST, LAKE GENEVA, WI 53147-2052
(262) 248-3148
Mailing address
211 S CURTIS ST, LAKE GENEVA, WI 53147-2052
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336141357
FACILITY NPI
—
Enumeration date
04/20/2022
Last updated
04/20/2022
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