| NPI | 1073232658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTA LARSON Owner, Doctor Of Physical Therapy 920-770-4150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2022-08-25 |