Healthcare Provider Details

I. General information

NPI: 1447398425
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WASHINGTON ST SUITE 3
TWO RIVERS WI
54241-3043
US

IV. Provider business mailing address

2300 COIT RD STE 200
PLANO TX
75075-3768
US

V. Phone/Fax

Practice location:
  • Phone: 920-553-8993
  • Fax: 920-553-8990
Mailing address:
  • Phone: 469-467-8705
  • Fax: 267-321-2550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateWI

VIII. Authorized Official

Name: RICHARD S. BINSTEIN
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 901-685-7227