Provider Demographics
NPI:1316977630
Name:PINNACLE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZUR
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:262-853-0184
Mailing Address - Street 1:224 BUTTERNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4910
Mailing Address - Country:US
Mailing Address - Phone:262-853-0184
Mailing Address - Fax:262-241-9881
Practice Address - Street 1:224 BUTTERNUT ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-4910
Practice Address - Country:US
Practice Address - Phone:262-853-0184
Practice Address - Fax:262-241-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty