Healthcare Provider Details

I. General information

NPI: 1336835339
Provider Name (Legal Business Name): CONNECTED CORE PHYSICAL THERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 12/03/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BELLAIRE CT
APPLETON WI
54911-5264
US

IV. Provider business mailing address

6 BELLAIRE CT
APPLETON WI
54911-5264
US

V. Phone/Fax

Practice location:
  • Phone: 920-428-3301
  • Fax:
Mailing address:
  • Phone: 920-428-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEAGAN PEETERS GEBLER
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 920-428-3301