Healthcare Provider Details

I. General information

NPI: 1265789127
Provider Name (Legal Business Name): OHNSTAD THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 STATE ROAD 70
GRANTSBURG WI
54840-7837
US

IV. Provider business mailing address

445 STATE ROAD 70
GRANTSBURG WI
54840-7837
US

V. Phone/Fax

Practice location:
  • Phone: 715-463-2075
  • Fax: 715-463-2076
Mailing address:
  • Phone: 715-463-2075
  • Fax: 715-463-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberWI 4292-24
License Number StateWI

VIII. Authorized Official

Name: RENAE ANDREA ROMBACH
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 715-463-2075