| NPI | 1780022525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM KO Business Manager 920-356-0122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: WI 12384-24) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2013-06-13 |