MEDICARE: FRESH START PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1588610562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESH START PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	10412 N BAEHR RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-4472
Country	:	US
Telephone Number	:	262-236-0176
Fax Number	:	262-236-0178

Provider Business Practice Location Address
First Line	:	10412 N BAEHR RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-4472
Country	:	US
Telephone Number	:	262-236-0176
Fax Number	:	262-236-0178

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	CHARISE WORTHINGTON
Credential	:
Telephone Number	:	262-236-0176

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	12/04/2024

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Directions to “FRESH START PHYSICAL THERAPY LLC ” Practice Location

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