| NPI | 1952597486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER JOHN JACQUES Owner CEO 920-540-8840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 3448024) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2013-01-30 |