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General NPI Number Information
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NPI Number | 1013214709
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Entity Type | Organization
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Legal Business Name | THREE GAITS, INC
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 3741 STATE ROAD 138
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City | STOUGHTON
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State | WI
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Zip | 53589-3713
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Country | US
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Telephone | 608-877-9086
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Fax | 608-873-1929
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Provider Business Mailing Address
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Address Line | PO BOX 153
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City | OREGON
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State | WI
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Zip | 53575-0153
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Country | US
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Telephone | 608-877-9086
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Fax | 608-873-1929
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DENA DUNCAN
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Credential |
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Telephone | 608-877-9086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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