Healthcare Provider Details

I. General information

NPI: 1245548882
Provider Name (Legal Business Name): PRECISION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W. SOUTH STREET
ONTARIO WI
54651
US

IV. Provider business mailing address

S. 610 DOWNING RD.
ONTARIO WI
54651-7531
US

V. Phone/Fax

Practice location:
  • Phone: 608-337-4222
  • Fax: 608-337-4222
Mailing address:
  • Phone: 608-337-4222
  • Fax: 608-337-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4268-024
License Number StateWI

VIII. Authorized Official

Name: MR. MARK PATRICK ESSLING
Title or Position: CEO
Credential:
Phone: 763-689-5585