Provider Demographics
NPI:1487491205
Name:RIVERSIDE PHYSICAL THERAPY & PELVIC HEALTH, S.C.
Entity type:Organization
Organization Name:RIVERSIDE PHYSICAL THERAPY & PELVIC HEALTH, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-627-2220
Mailing Address - Street 1:4440 HARTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9034
Mailing Address - Country:US
Mailing Address - Phone:262-627-2220
Mailing Address - Fax:262-284-9511
Practice Address - Street 1:516 E GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:SAUKVILLE
Practice Address - State:WI
Practice Address - Zip Code:53080-2012
Practice Address - Country:US
Practice Address - Phone:262-284-9510
Practice Address - Fax:262-284-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty