Provider Demographics
NPI:1578393765
Name:SHISSLER, BROOKE OLIVIA (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:OLIVIA
Last Name:SHISSLER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 MANKIN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8710
Mailing Address - Country:US
Mailing Address - Phone:215-800-7566
Mailing Address - Fax:
Practice Address - Street 1:855 S NEW STREET
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19383-0001
Practice Address - Country:US
Practice Address - Phone:215-800-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0084642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer