Healthcare Provider Details

I. General information

NPI: 1831106020
Provider Name (Legal Business Name): BRIAN D. LEASE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HOSPITAL RD WESTFIELDS HOSPITAL, PT DEPT.
NEW RICHMOND WI
54017-1449
US

IV. Provider business mailing address

1386 211TH AVE
NEW RICHMOND WI
54017-7151
US

V. Phone/Fax

Practice location:
  • Phone: 715-243-7255
  • Fax: 715-243-7222
Mailing address:
  • Phone: 715-781-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6221-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: