Basic Information
Provider Information
NPI: 1003018219
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SASSE
FirstName: MONICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: W3985 COUNTY ROAD NN
Address2:  
City: ELKHORN
State: WI
PostalCode: 531214337
CountryCode: US
TelephoneNumber: 4146476326
FaxNumber:  
Practice Location
Address1: W3985 COUNTY ROAD NN
Address2:  
City: ELKHORN
State: WI
PostalCode: 531214337
CountryCode: US
TelephoneNumber: 4146476326
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/01/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X10076WIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
4047100005WI MEDICAID


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