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General NPI Number Information
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NPI Number | 1871734806
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Entity Type | Organization
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Legal Business Name | ERIC KOEHLER LLC
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Dates
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Enumeration Date | 03/21/2009
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Last Update Date | 03/21/2009
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Provider Practice Location Address
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Address Line | 3111 SAWYER CREEK DR
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City | OSHKOSH
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State | WI
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Zip | 54904-6362
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Country | US
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Telephone | 920-379-9692
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 SAWYER CREEK DR
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City | OSHKOSH
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State | WI
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Zip | 54904-6362
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Country | US
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Telephone | 920-379-9692
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. ERIC LEO KOEHLER
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Credential | PT
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Telephone | 920-379-9692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4017-024
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License Number State | WI
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