| NPI | 1316977630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS MAZUR Owner/Physical Therapist 262-853-0184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 4798) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-08-22 |