1447950951 NPI number — SWITZ PEDIATRIC PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447950951 NPI number — SWITZ PEDIATRIC PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWITZ PEDIATRIC PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447950951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1735 PARK RIDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH FOND DU LAC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54937-1094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 W ROLLING MEADOWS DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOND DU LAC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54937-8624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-517-7130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SWITZ
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
920-517-7130

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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