Healthcare Provider Details

I. General information

NPI: 1639492085
Provider Name (Legal Business Name): LAKELAND PHYSICAL THERAPY L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27477 STATE HIGHWAY 64 SUITE C
CORNELL WI
54732-5222
US

IV. Provider business mailing address

27477 STATE HIGHWAY 64 SUITE C
CORNELL WI
54732-5222
US

V. Phone/Fax

Practice location:
  • Phone: 715-239-0555
  • Fax: 715-239-0556
Mailing address:
  • Phone: 715-379-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number10210-024
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSEPH BORTON
Title or Position: OWNER
Credential:
Phone: 715-239-0555