MEDICARE: NISSENBAUM AND SCHLEUSNER PRO PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1316767213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NISSENBAUM AND SCHLEUSNER PRO PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	972 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2039
Country	:	US
Telephone Number	:	608-413-0550
Fax Number	:	608-413-0552

Provider Business Practice Location Address
First Line	:	972 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2039
Country	:	US
Telephone Number	:	608-413-0550
Fax Number	:	608-413-0552

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	ANGELA WEBB-BUFFINGTON
Credential	:
Telephone Number	:	608-413-0550

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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