Provider Demographics
NPI:1881940104
Name:WILD, ALISON E (DPT)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:E
Last Name:WILD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 W OAKWOOD PARK CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9118
Mailing Address - Country:US
Mailing Address - Phone:414-855-2870
Mailing Address - Fax:414-855-2871
Practice Address - Street 1:4202 W OAKWOOD PARK CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9118
Practice Address - Country:US
Practice Address - Phone:414-855-2870
Practice Address - Fax:414-855-2870
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12140-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100193358Medicaid