Individual
ALISE SHORE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 PINE ST, STANLEY, WI 54768-0220
(715) 644-6181
(715) 644-6183
Mailing address
1120 PINE ST, PO BOX 220, STANLEY, WI 54768-0220
(715) 644-6181
(715) 644-6183
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
604-019
WI
Other
Enumeration date
02/15/2006
Last updated
07/08/2007
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