Provider Demographics
NPI:1851501852
Name:CRESCO, PATRICIA A
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:CRESCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9256 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9518
Mailing Address - Country:US
Mailing Address - Phone:262-994-0596
Mailing Address - Fax:
Practice Address - Street 1:1700 C A BECKER DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4714
Practice Address - Country:US
Practice Address - Phone:262-898-2777
Practice Address - Fax:262-619-1547
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI161-019314000000X
WI16119225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility