Individual
LISA BLACKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3431 N 13TH ST, SHEBOYGAN, WI 53083-2938
(920) 457-5046
Mailing address
W6680 COUNTY ROAD JP, ELKHART LAKE, WI 53020-1903
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
10/02/2025
Last updated
10/02/2025
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