Healthcare Provider Details

I. General information

NPI: 1073735999
Provider Name (Legal Business Name): EMILY JOY HOTCHKISS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY JOY LUCASSEN P.T.

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 SAINT ANTHONY DR PARKVIEW MANOR, ATTENTION EMILY PT
GREEN BAY WI
54311-5860
US

IV. Provider business mailing address

2961 SAINT ANTHONY DR
GREEN BAY WI
54311-5860
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-0861
  • Fax: 920-569-1566
Mailing address:
  • Phone: 920-468-0861
  • Fax: 920-468-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10203-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: