Provider Demographics
NPI:1225872625
Name:HALLISY, MADELINE JEANNE (DPT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:JEANNE
Last Name:HALLISY
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 LITTLE PICKEREL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT GERMAIN
Mailing Address - State:WI
Mailing Address - Zip Code:54558-9422
Mailing Address - Country:US
Mailing Address - Phone:262-220-3110
Mailing Address - Fax:
Practice Address - Street 1:2251 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-6710
Practice Address - Country:US
Practice Address - Phone:715-361-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16687-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist