| Organization Name: | NEW LIFE PHYSICAL THERAPY & SPORTS MEDICINE |
| NPI Number: | 1033522354 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY ROSE LUCIANO (PHYSICAL THERAPIST / COO) |
| Mailing Address: | 2639 New Pinery Rd Ste 2 Portage |
| State: | WI US |
| Postal Code: | 539011110 |
| Phone Number: | 6087429356 |
| Fax Number: | |
| NPI Enumeration Date: | 06/04/2014 |
| NPI Last Update Date: | 06/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PTL.0012676 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |