Healthcare Provider Details

I. General information

NPI: 1104619550
Provider Name (Legal Business Name): FULL CIRCLE THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S BROADWAY
DE PERE WI
54115-8299
US

IV. Provider business mailing address

1325 S BROADWAY
DE PERE WI
54115-8299
US

V. Phone/Fax

Practice location:
  • Phone: 920-321-8366
  • Fax:
Mailing address:
  • Phone: 920-321-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DENISE COPPENS
Title or Position: BILLING MANAGER
Credential:
Phone: 920-321-8366