Provider Demographics
NPI:1174216204
Name:BLISKE, CLARA
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:BLISKE
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:N92W6960 WASHINGTON CT APT 24
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-3239
Mailing Address - Country:US
Mailing Address - Phone:608-234-7476
Mailing Address - Fax:
Practice Address - Street 1:N92W6960 WASHINGTON CT APT 24
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-3239
Practice Address - Country:US
Practice Address - Phone:608-234-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy