Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070.010640 | IL |
N | 225100000X | Physical Therapist | 11-01243 | KS |
N | 225100000X | Physical Therapist | 1134039 | TX |
N | 225100000X | Physical Therapist | 19444 | CA |
Y | 225100000X | Physical Therapist | 5876-24 | WI |
NPI | 1003174855 |
---|---|
Provider Name | Cheryl Lasselle |
First Address | Mount Pleasant, WI 53406-2051 |
Second Address | Mount Pleasant, WI 53406-2051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 30/04/2012 |