Individual
GARY SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
N15W28300 GOLF RD, PEWAUKEE, WI 53072-4800
(262) 303-5055
Mailing address
N15W28300 GOLF RD, PEWAUKEE, WI 53072-4800
(262) 303-5055
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
14763-24
WI
Other
Enumeration date
06/07/2019
Last updated
08/29/2023
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