Provider Demographics
NPI:1033533500
Name:LITSHEIM, MEGAN ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANNE
Last Name:LITSHEIM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N CAMBRIDGE AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1000
Mailing Address - Country:US
Mailing Address - Phone:608-774-1807
Mailing Address - Fax:
Practice Address - Street 1:2429 E BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4100
Practice Address - Country:US
Practice Address - Phone:414-963-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12498-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist