Healthcare Provider Details

I. General information

NPI: 1730249632
Provider Name (Legal Business Name): DAVID LEE SEITZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N1418 TIMBER VALLEY RD
LA CROSSE WI
54601-2172
US

IV. Provider business mailing address

N1418 TIMBER VALLEY RD
LA CROSSE WI
54601-2172
US

V. Phone/Fax

Practice location:
  • Phone: 608-787-6386
  • Fax: 608-788-4543
Mailing address:
  • Phone: 608-787-6386
  • Fax: 608-788-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3318024
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3318-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: