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General NPI Number Information
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NPI Number | 1932343670
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE REHABILITATION INDEPENDENT SERVICES, SC
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 4863 ENCHANTED VALLEY RD
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City | MIDDLETON
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State | WI
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Zip | 53562-4118
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Country | US
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Telephone | 608-843-5074
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Fax |
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Provider Business Mailing Address
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Address Line | 4863 ENCHANTED VALLEY RD
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City | MIDDLETON
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State | WI
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Zip | 53562-4118
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Country | US
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Telephone | 608-843-5074
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM E FOWLER
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Credential | MD
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Telephone | 608-843-5074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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