Healthcare Provider Details

I. General information

NPI: 1487004669
Provider Name (Legal Business Name): RACHEL WOJTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 JANESVILLE ST
OREGON WI
53575-2954
US

IV. Provider business mailing address

900 RIDGE ST
STOUGHTON WI
53589-1864
US

V. Phone/Fax

Practice location:
  • Phone: 608-835-5373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13410
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13410-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: