Healthcare Provider Details

I. General information

NPI: 1215420021
Provider Name (Legal Business Name): BRETT LOPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 S COMMERCIAL ST
NEENAH WI
54956-4801
US

IV. Provider business mailing address

1511 S COMMERCIAL ST
NEENAH WI
54956-4801
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-0660
  • Fax: 920-720-0666
Mailing address:
  • Phone: 920-720-0660
  • Fax: 920-720-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: