Individual
KARISSA MCCORISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 W BREWSTER ST, APPLETON, WI 54914-6444
(920) 832-1657
Mailing address
2912 SHADE TREE LN, GREEN BAY, WI 54313-7082
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2674
WI
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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