Healthcare Provider Details

I. General information

NPI: 1497733513
Provider Name (Legal Business Name): FOX VALLEY PHYSICAL THERAPY & WELLNESS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S WASHBURN ST
OSHKOSH WI
54904-8051
US

IV. Provider business mailing address

909 S WASHBURN ST
OSHKOSH WI
54904-8051
US

V. Phone/Fax

Practice location:
  • Phone: 920-235-8966
  • Fax:
Mailing address:
  • Phone: 920-235-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEVEN PAUL SOBOJINSKI
Title or Position: PRESIDENT/OCCUPATIONAL THERAPIST
Credential: O.T.R.
Phone: 920-235-8966