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General NPI Number Information
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NPI Number | 1558375493
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Entity Type | Organization
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Legal Business Name | CHIPPEWA VALLEY PHYSICAL THERAPY SC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 320 SUMMIT CT
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3599
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Country | US
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Telephone | 715-726-1010
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Fax | 715-720-1010
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Provider Business Mailing Address
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Address Line | PO BOX 16
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-0016
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Country | US
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Telephone | 715-726-1010
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Fax | 715-726-1010
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ROBERT S JOHNSON
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Credential | PT
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Telephone | 715-726-1010
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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 | WI
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