Provider Demographics
NPI:1538491006
Name:WUEBBEN, SHARI L (PTA)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:L
Last Name:WUEBBEN
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 1:905 ACKER PKWY
Mailing Address - Street 2:
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-3018
Mailing Address - Country:US
Mailing Address - Phone:608-846-5896
Mailing Address - Fax:
Practice Address - Street 1:5833 AMERICAN PKWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-8325
Practice Address - Country:US
Practice Address - Phone:608-230-4681
Practice Address - Fax:608-230-4680
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI019-1114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant