Healthcare Provider Details

I. General information

NPI: 1871291823
Provider Name (Legal Business Name): NISSENBAUM AND SCHLEUSNER PRO PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ETC DR
MAZOMANIE WI
53560-9832
US

IV. Provider business mailing address

1118 MAIN ST STE A
CROSS PLAINS WI
53528-9477
US

V. Phone/Fax

Practice location:
  • Phone: 608-413-0550
  • Fax: 608-413-0552
Mailing address:
  • Phone: 608-413-0550
  • Fax: 608-413-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA WEBB-BUFFINGTON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 608-413-0550