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General NPI Number Information
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NPI Number | 1700217205
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Entity Type | Organization
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Legal Business Name | FUSION PHYSICAL THERAPY AND WELLNESS
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | N49W6693 WESTERN RD
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City | CEDARBURG
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State | WI
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Zip | 53012-1804
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Country | US
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Telephone | 414-412-8072
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 170826
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City | MILWAUKEE
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State | WI
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Zip | 53217-8076
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Country | US
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Telephone | 414-412-8072
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Fax |
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Authorized Official
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Title or Position | DOCATORATE PHYSICAL THERAPY
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Name | KRISTIN M NOVAK
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Credential | DPT
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Telephone | 414-412-8072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 10888-24
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License Number State | WI
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