Tisdale, Mark R

Tisdale, Mark R is an individual health care provider with primary practice located at 10400 75Th Street , Kenosha WI 53142. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as his primary health care specialty. Tisdale, Mark R can be contacted via phone (262) 948-7045.

Contact Information

Primary practice address
10400 75Th Street Kenosha WI 53142
Phone: (262) 948-7045
Fax: (262) 948-7331
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 897-019 Wisconsin

Profile Details

NPI number 1154626745
LBN Legal business name Tisdale, Mark R
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 13th, 2011
Last updated Jan 13th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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