Healthcare Provider Details

I. General information

NPI: 1578853990
Provider Name (Legal Business Name): HWPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19035 W CAPITOL DR SUITE 100
BROOKFIELD WI
53045-2755
US

IV. Provider business mailing address

19035 W CAPITOL DR SUITE 100
BROOKFIELD WI
53045-2755
US

V. Phone/Fax

Practice location:
  • Phone: 262-695-6744
  • Fax: 262-695-6466
Mailing address:
  • Phone: 262-695-6744
  • Fax: 262-695-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANE M HUBER
Title or Position: PRESIDENT
Credential: DC
Phone: 262-695-6744