Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark R Tisdale, PTA

Individual provider Physical Therapy Assistant · NPI 1154626745

Mark R Tisdale, PTA is a Physical Therapy Assistant in Kenosha, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2011.

Licensed in
WI
In the registry since
2011
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

See every abbreviation used in this directory →

Practice location Address checks out

10400 75th St
Kenosha, WI 53142
Phone: (262) 948-7045
Fax: (262) 948-7331
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 897-019 (WI)

Record details

NPI number1154626745
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedJanuary 13, 2011
Last updated in NPPESJanuary 13, 2011

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