| NPI | 1366716987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN DUFAULT Licensed Athletic Trainer 608-250-1775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11909-24) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2021-07-16 |