Provider Demographics
NPI:1588657902
Name:SISCHO, JEFFREY P (DPT, LAT, PT)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:SISCHO
Suffix:
Gender:M
Credentials:DPT, LAT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 E DIANE DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3483
Mailing Address - Country:US
Mailing Address - Phone:414-570-1450
Mailing Address - Fax:
Practice Address - Street 1:100 N EAST AVE
Practice Address - Street 2:PT BUILDING, #116
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3103
Practice Address - Country:US
Practice Address - Phone:262-951-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137-0392255A2300X
WI10699-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI001281050Medicare ID - Type Unspecified