Individual
CORISSA M LEASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1218 STATE ST, BLACK EARTH, WI 53515
(608) 767-2572
Mailing address
308 S HARRISON ST, BELLEVILLE, WI 53508-9302
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
02/01/2021
Last updated
02/01/2021
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