Healthcare Provider Details

I. General information

NPI: 1245349083
Provider Name (Legal Business Name): BART HEBERT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8554 HWY 51 NORTH
MINOCQUA WI
54548
US

IV. Provider business mailing address

PO BOX 11
MINOCQUA WI
54548-0011
US

V. Phone/Fax

Practice location:
  • Phone: 715-358-1929
  • Fax: 715-356-4031
Mailing address:
  • Phone: 715-358-1929
  • Fax: 715-356-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2936-04
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2936-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: