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General NPI Number Information
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NPI Number | 1558063057
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Entity Type | Organization
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Legal Business Name | PRO-ACTIVE PHYSICAL THERAPY, S.C.
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | W4076 FREDONIA KOHLER RD
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City | FREDONIA
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State | WI
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Zip | 53021
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Country | US
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Telephone | 262-939-5237
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Fax |
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Provider Business Mailing Address
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Address Line | W4076 FREDONIA KOHLER RD
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City | FREDONIA
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State | WI
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Zip | 53021
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Country | US
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Telephone | 262-939-5237
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Fax |
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Authorized Official
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Title or Position | OWNER/P.T.
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Name | MRS. JULIE ANN SCHUELLER
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Credential | DPT
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Telephone | 262-939-5237
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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 |
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License Number State |
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