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General NPI Number Information
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NPI Number | 1912496019
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Entity Type | Organization
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Legal Business Name | NORTHERN DOOR PHYSICAL THERAPY & WELLNESS LLC
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 10578 COUNTRY WALK DR UNIT 29
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City | SISTER BAY
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State | WI
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Zip | 54234-9114
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Country | US
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Telephone | 920-242-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 10486 W STONY RIDGE CIR UNIT 24
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City | SISTER BAY
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State | WI
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Zip | 54234-8912
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Country | US
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Telephone | 920-242-1122
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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 | DR. KEITH FISHER
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Credential | PT, DPT, OCS, MTC
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Telephone | 920-242-1122
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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 |
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License Number State |
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