Healthcare Provider Details

I. General information

NPI: 1609448596
Provider Name (Legal Business Name): NISSENBAUM AND SCHLEUSNER PRO PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 COMMERCE PARK DR STE B
FITCHBURG WI
53719-5136
US

IV. Provider business mailing address

1118 MAIN ST STE A
CROSS PLAINS WI
53528-9477
US

V. Phone/Fax

Practice location:
  • Phone: 608-413-0550
  • Fax: 608-413-0552
Mailing address:
  • Phone: 608-413-0550
  • Fax: 608-413-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA WEBB-BUFFINGTON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 608-413-0550