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General NPI Number Information
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NPI Number | 1023277688
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Entity Type | Organization
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Legal Business Name | WAUNAKEE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/08/2008
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Last Update Date | 06/08/2008
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Provider Practice Location Address
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Address Line | 301 E 3RD ST
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City | WAUNAKEE
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State | WI
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Zip | 53597-2436
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Country | US
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Telephone | 608-235-5527
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Fax |
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Provider Business Mailing Address
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Address Line | 205 BACON ST
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City | WAUNAKEE
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State | WI
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Zip | 53597-1425
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Country | US
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Telephone | 608-235-5527
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | HEATHER HARTWIG STOKES
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Credential |
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Telephone | 608-235-5527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9741-024
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License Number State | WI
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