Healthcare Provider Details

I. General information

NPI: 1265367486
Provider Name (Legal Business Name): DENISE THEYERL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 PARK PL
ELKHART LAKE WI
53020-1226
US

IV. Provider business mailing address

451 PARK PL
ELKHART LAKE WI
53020-1226
US

V. Phone/Fax

Practice location:
  • Phone: 715-579-1396
  • Fax:
Mailing address:
  • Phone: 715-579-1396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number3725-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3725-24
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number3725-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: