| NPI | 1104619550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE COPPENS Billing Manager 920-321-8366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-06-04 |