Healthcare Provider Details

I. General information

NPI: 1164720587
Provider Name (Legal Business Name): GENOA CITY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 FREEMAN STREET
GENOA CITY WI
53128
US

IV. Provider business mailing address

5809 ROCKY BRANCH RD
SIGNAL MOUNTAIN TN
37377-1338
US

V. Phone/Fax

Practice location:
  • Phone: 262-279-8000
  • Fax: 262-295-8799
Mailing address:
  • Phone: 847-254-1708
  • Fax: 423-269-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9814-24
License Number StateWI

VIII. Authorized Official

Name: NICHOLAS A BATSON
Title or Position: OWNER
Credential: DPT
Phone: 847-254-1708