Provider Demographics
NPI:1427384791
Name:KASTEN, SHANNON LEA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEA
Last Name:KASTEN
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 1:440 WELLS ST
Mailing Address - Street 2:SUITE200
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1409
Mailing Address - Country:US
Mailing Address - Phone:479-201-2844
Mailing Address - Fax:
Practice Address - Street 1:440 WELLS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1409
Practice Address - Country:US
Practice Address - Phone:479-201-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1211-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant