=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518700699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOREMOST PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2024
-----------------------------------------------------
Last Update Date | 06/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 HOLLY CT
-----------------------------------------------------
City | PRAIRIE DU SAC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53578-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-382-3627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 HOLLY CT
-----------------------------------------------------
City | PRAIRIE DU SAC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53578-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST, ATHLETIC TRAINE
-----------------------------------------------------
Name | RYAN JACOB SCHMITT
-----------------------------------------------------
Credential | DPT, ATC
-----------------------------------------------------
Telephone | 920-382-3627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------