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
Mailing address10400 75th Street, Kenosha, WI 53142

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