| Doctor Name: | MRS. THERESA A WYSOCKI |
| NPI Number: | 1164623062 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | B.E. |
| License Number: | N.A. |
| Business Practice Address: | 575 Briarwood Ln Port Washington, WI - 530741322 |
| Business Phone Number: | 2622844235 |
| Business Fax Number: | 2622844235 |
| Mailing Address: | 575 Briarwood Ln, PORT WASHINGTON |
| State: | WI |
| Postal Code: | 530741322 |
| Phone Number: | 2622844235 |
| Fax Number: | 2622844235 |
| NPI Enumeration Date: | 05/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1744P3200X |
| License Number: | N.A. |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | Prosthetics Case Management |
| Taxonomy Definition: | |