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General NPI Number Information
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NPI Number | 1124016407
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Entity Type | Organization
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Legal Business Name | OCONTO PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 300 N BROADWAY SUITE 3C
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City | GREEN BAY
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State | WI
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Zip | 54303-2702
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Country | US
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Telephone | 920-437-7246
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Fax | 920-437-1511
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Provider Business Mailing Address
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Address Line | 300 N BROADWAY SUITE 3C
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City | GREEN BAY
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State | WI
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Zip | 54303-2702
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Country | US
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Telephone | 920-437-7246
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Fax | 920-437-1511
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CYNTHIA L WILLETTE
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Credential |
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Telephone | 920-437-7246
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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 | 2368
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1934
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License Number State | WI
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