| NPI | 1578853990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE M HUBER President 262-695-6744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2015-01-14 |