Healthcare Provider Details

I. General information

NPI: 1073599783
Provider Name (Legal Business Name): WAUKESHA PHYSICAL THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HARTBROOK DR STE 111
HARTLAND WI
53029-1436
US

IV. Provider business mailing address

600 HARTBROOK DR STE 111
HARTLAND WI
53029-1436
US

V. Phone/Fax

Practice location:
  • Phone: 262-367-3110
  • Fax: 262-367-3112
Mailing address:
  • Phone: 262-367-3110
  • Fax: 262-367-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GABRIELE H LANGAN
Title or Position: OWNER
Credential: PT
Phone: 262-367-3110