=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114169943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PTWORKS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2009
-----------------------------------------------------
Last Update Date | 03/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 690 KENNEDY STREET
-----------------------------------------------------
City | MAUSTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-847-5100
-----------------------------------------------------
Fax | 608-847-5110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 319
-----------------------------------------------------
City | MAUSTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53948-0319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-847-5100
-----------------------------------------------------
Fax | 608-847-5110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | LORI WEBSTER-DAHL
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 608-847-5100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------