Provider Demographics
NPI:1891860839
Name:ST LOUIS, JOANNE KAY (PTA)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:KAY
Last Name:ST LOUIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:KAY
Other - Last Name:LESPERANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3110 WEST MINNESOTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132
Mailing Address - Country:US
Mailing Address - Phone:414-761-2988
Mailing Address - Fax:
Practice Address - Street 1:INNOVATIVE REHABILITATION
Practice Address - Street 2:8800 5102ND ST
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132
Practice Address - Country:US
Practice Address - Phone:414-448-3097
Practice Address - Fax:414-425-9701
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant