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General NPI Number Information
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NPI Number | 1871066233
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Entity Type | Organization
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Legal Business Name | IMPACT PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 485 CLINTON CT
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City | AMHERST
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State | WI
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Zip | 54406-9203
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Country | US
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Telephone | 715-824-4460
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Fax | 715-824-3278
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Provider Business Mailing Address
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Address Line | PO BOX 324
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City | AMHERST
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State | WI
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Zip | 54406-0324
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Country | US
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Telephone | 715-529-3487
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Fax | 715-251-6236
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRETT ROBERTS
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Credential | DPT
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Telephone | 715-529-3487
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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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