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General NPI Number Information
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NPI Number | 1962649871
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Entity Type | Organization
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Legal Business Name | WELLNESS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 4539 WOODGATE DR SUITE A
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City | JANESVILLE
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State | WI
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Zip | 53546-8205
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Country | US
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Telephone | 608-359-1737
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Fax |
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Provider Business Mailing Address
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Address Line | 4139 WINDMILL LN
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City | JANESVILLE
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State | WI
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Zip | 53546-4206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE KOTH
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Credential | MPT
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Telephone | 608-359-1737
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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 | 6430024
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License Number State | WI
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