Provider Demographics
NPI:1962197863
Name:ANSCHUTZ, ALISHA R (D-PT)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:R
Last Name:ANSCHUTZ
Suffix:
Gender:F
Credentials:D-PT
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:R
Other - Last Name:MACIEJEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D-PT
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:704 S WEBSTER AVE STE 201
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3528
Practice Address - Country:US
Practice Address - Phone:920-433-3410
Practice Address - Fax:920-433-3419
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14186-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist