Healthcare Provider Details

I. General information

NPI: 1194878645
Provider Name (Legal Business Name): THOMAS WILLIAM WOJTA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 1ST ST
PRAIRIE DU SAC WI
53578-1550
US

IV. Provider business mailing address

2254 FOX AVE
MADISON WI
53711-1923
US

V. Phone/Fax

Practice location:
  • Phone: 608-643-7263
  • Fax: 608-643-7667
Mailing address:
  • Phone: 608-256-8068
  • Fax: 608-643-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5667-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: