Doctor Name: | SHANA BLACKMAN |
NPI Number: | 1891192647 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 11775-024 |
Business Practice Address: | 1139 S Sunnyslope Dr Suite 203 Mount Pleasant, WI - 534063998 |
Business Phone Number: | 2623210240 |
Business Fax Number: | 2623210242 |
Mailing Address: | 2560 N 81st St, WAUWATOSA |
State: | WI |
Postal Code: | 532131015 |
Phone Number: | 4144790776 |
Fax Number: | |
NPI Enumeration Date: | 11/21/2014 |
NPI Last Update Date: | 11/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 11775-024 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |