| NPI | 1639661119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENIFER LYNNE TILLMANN Credentialing 920-560-1147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2022-11-02 |