Provider Demographics
NPI:1568969681
Name:HELGERSON, LEISHA (ATC)
Entity Type:Individual
Prefix:
First Name:LEISHA
Middle Name:
Last Name:HELGERSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2863 COUNTY ROAD T
Mailing Address - Street 2:
Mailing Address - City:MINDORO
Mailing Address - State:WI
Mailing Address - Zip Code:54644-9481
Mailing Address - Country:US
Mailing Address - Phone:608-799-8238
Mailing Address - Fax:
Practice Address - Street 1:3111 GUNDERSEN DR
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8447
Practice Address - Country:US
Practice Address - Phone:608-775-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1631-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer