Edward J Lesniak, PTA
Individual provider Active NPI Physical Therapy Assistant · Waterford, WI
NPI 1770701401 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1770701401
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 1053-019 (WI)
- Practice address
- 1701 Sharp Rd
Waterford, WI 53185-5214 - Phone
- (262) 534-7297
- Fax
- (262) 534-7257
- NPI assigned
- Apr 20, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1053-019 | WI | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1053-019 | WI | Yes |
Addresses
Primary practice location
1701 Sharp Rd
Waterford, WI 53185-5214
Mailing address
507 Jerome CT
Elkhorn, WI 53121-1683
Phone (262) 723-5747
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40361500 | Medicaid | WI |
Other providers in Waterford, WI
- Lakeview Neurorehab Center Midwest, Inc
- Lakeview Neurorehab Center Midwest, Inc.
- Jonathan Lancourt
- Ashlee Leidall
- Sarah Lesch
- Charity R Lopez
- Jennifer Lucas
- Ashley Lucht
- Mustansir Majeed
- Lamberto Y Malinis Jr.
All providers in Waterford, WI · Physical Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.