Provider Demographics
NPI:1598512469
Name:SCALISE, KRISTIE LYNNE (PTA)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNNE
Last Name:SCALISE
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 1:517 TUDOR DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2012
Mailing Address - Country:US
Mailing Address - Phone:815-988-9805
Mailing Address - Fax:
Practice Address - Street 1:700 MYRTLE WAY
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-9111
Practice Address - Country:US
Practice Address - Phone:608-530-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2951-192251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics