| NPI | 1407857790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENIFER LYNNE TILLMANN Credentialing 920-560-1147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-04-27 |