Individual
MARK T HILLESHEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3130 SHORE DR, MARINETTE, WI 54143-4291
(715) 735-4609
Mailing address
5476 MICHAELS DR, #6, APPLETON, WI 54913-8663
(920) 730-4030
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3372
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40137800
—
WI
Enumeration date
03/15/2007
Last updated
07/08/2007
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