Organization Name: | FIVE CORNERS PHYSICAL THERAPY S.C. |
NPI Number: | 1427195304 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY JOHN PROVENCHER (PRESIDENT) |
Mailing Address: | 7269 State Road 60 Suite 1 Cedarburg |
State: | WI US |
Postal Code: | 530129702 |
Phone Number: | 2623778350 |
Fax Number: | 2623778390 |
NPI Enumeration Date: | 01/31/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 4146-024 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | WI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |