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General NPI Number Information
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NPI Number | 1366535742
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Entity Type | Organization
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Legal Business Name | LIFESPEED PHYSICAL THERAPY AND FITNESS
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | N64W24678 MAIN ST SUITE B
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City | SUSSEX
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State | WI
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Zip | 53089
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Country | US
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Telephone | 262-820-2686
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Fax | 866-245-8064
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Provider Business Mailing Address
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Address Line | 8700 DURAND AVE SUITE D
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City | STURTEVANT
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State | WI
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Zip | 53177
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Country | US
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Telephone | 877-552-2996
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Fax | 866-245-8064
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. LARRY D BRIAND
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Credential |
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Telephone | 877-552-2996
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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 | 6020-024
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License Number State | WI
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