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General NPI Number Information
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NPI Number | 1639492085
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Entity Type | Organization
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Legal Business Name | LAKELAND PHYSICAL THERAPY L.L.C.
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 27477 STATE HIGHWAY 64 SUITE C
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City | CORNELL
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State | WI
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Zip | 54732-5222
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Country | US
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Telephone | 715-239-0555
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Fax | 715-239-0556
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Provider Business Mailing Address
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Address Line | 27477 STATE HIGHWAY 64 SUITE C
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City | CORNELL
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State | WI
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Zip | 54732-5222
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Country | US
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Telephone | 715-379-0916
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH BORTON
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Credential |
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Telephone | 715-239-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 10210-024
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License Number State | WI
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