Provider Demographics
NPI:1023277688
Name:WAUNAKEE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WAUNAKEE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTWIG STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-235-5527
Mailing Address - Street 1:205 BACON ST
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1425
Mailing Address - Country:US
Mailing Address - Phone:608-235-5527
Mailing Address - Fax:
Practice Address - Street 1:301 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2436
Practice Address - Country:US
Practice Address - Phone:608-235-5527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9741-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty