Basic Information
| Provider Information | |||||||||
| NPI: | 1295255859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEK | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | GALSTAD | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | GALSTAD | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4634 N SHEFFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | WHITEFISH BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532111106 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2455 N 124TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530054630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627829326 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2017 | ||||||||
| LastUpdateDate: | 06/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.