Provider Demographics
NPI:1477858215
Name:STAEHLI WISER, ANNA G (PT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:G
Last Name:STAEHLI WISER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:STAEHLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1830
Mailing Address - Country:US
Mailing Address - Phone:207-855-0715
Mailing Address - Fax:
Practice Address - Street 1:20 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1830
Practice Address - Country:US
Practice Address - Phone:207-855-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19331225100000X
MEPT2537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist