Healthcare Provider Details

I. General information

NPI: 1003648064
Provider Name (Legal Business Name): CHOICE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N1287 LAUDON LN
HORTONVILLE WI
54944-9382
US

IV. Provider business mailing address

1835 E EDGEWOOD DR STE 10583
APPLETON WI
54913-9407
US

V. Phone/Fax

Practice location:
  • Phone: 920-841-3018
  • Fax:
Mailing address:
  • Phone: 920-841-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTIN A JENNINGS
Title or Position: OWNER/PROVIDER
Credential: PT
Phone: 920-841-3018