Organization Name: | LAKES AREA PHYSICAL THERAPY, LLC |
NPI Number: | 1588845804 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN R VAN SUSTEREN (PHYSICAL THERAPIS / OWNER) |
Mailing Address: | 800 Geneva Pkwy N Suite 3 Lake Geneva |
State: | WI US |
Postal Code: | 531475701 |
Phone Number: | 2622489902 |
Fax Number: | 2622489419 |
NPI Enumeration Date: | 11/15/2007 |
NPI Last Update Date: | 04/07/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 4467024 |
Healthcare Provider Taxonomy: (Secondary) | Y |
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 |