Provider Demographics
NPI:1306903778
Name:SHILTS, JEANNE MARIE (PTA)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MARIE
Last Name:SHILTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PFLAUM RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2164
Mailing Address - Country:US
Mailing Address - Phone:608-527-4390
Mailing Address - Fax:608-527-4392
Practice Address - Street 1:600 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-9776
Practice Address - Country:US
Practice Address - Phone:608-527-4390
Practice Address - Fax:608-527-4392
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI936-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant