Healthcare Provider Details

I. General information

NPI: 1245398536
Provider Name (Legal Business Name): BECKY J LEASE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 14TH AVE
BALDWIN WI
54002-9030
US

IV. Provider business mailing address

505 KELLER AVE S
AMERY WI
54001
US

V. Phone/Fax

Practice location:
  • Phone: 715-684-3334
  • Fax:
Mailing address:
  • Phone: 715-268-6900
  • Fax: 715-268-6895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6207024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: