Healthcare Provider Details

I. General information

NPI: 1346081163
Provider Name (Legal Business Name): JUNIPER PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 S 10TH ST STE 104
MANITOWOC WI
54220-5209
US

IV. Provider business mailing address

1011 S 10TH ST STE 104
MANITOWOC WI
54220-5209
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-9838
  • Fax: 920-264-9665
Mailing address:
  • Phone: 920-320-9838
  • Fax: 920-264-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ELIZABETH WERGIN
Title or Position: OWNER & PHYSICAL THERAPIST
Credential: DPT
Phone: 920-320-9838