Healthcare Provider Details

I. General information

NPI: 1447189170
Provider Name (Legal Business Name): VITALITY HEALTH COLLABORATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W MILL ST
EAGLE RIVER WI
54521-8002
US

IV. Provider business mailing address

425 W MILL ST
EAGLE RIVER WI
54521-8002
US

V. Phone/Fax

Practice location:
  • Phone: 715-891-5011
  • Fax:
Mailing address:
  • Phone: 715-891-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA WEBER
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 715-891-5011