Provider Demographics
NPI:1639270978
Name:FASCIOTTI, PATRICIA F (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
Last Name:FASCIOTTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16355 ONONDAGA CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 E SAINT PAUL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5907
Practice Address - Country:US
Practice Address - Phone:414-272-9595
Practice Address - Fax:414-272-9594
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10353024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000180094Medicare PIN
WI000383042Medicare PIN
WI000180096Medicare PIN
WIP00447965Medicare PIN
WI832070002Medicare PIN