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General NPI Number Information
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NPI Number | 1083328785
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE PHYSICAL THERAPY AND REHAB SPECIALISTS LLC
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 224 RIVER AVE S
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City | PRAIRIE FARM
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State | WI
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Zip | 54762-9786
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Country | US
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Telephone | 715-263-4103
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 147
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City | CLEAR LAKE
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State | WI
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Zip | 54005-8905
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Country | US
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Telephone | 715-263-4103
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Fax |
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Authorized Official
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Title or Position | OWEN
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Name | EMILY J MONSON
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Credential | PT
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Telephone | 715-263-4103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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