1487491205 NPI number — RIVERSIDE PHYSICAL THERAPY & PELVIC HEALTH, S.C.

Table of content: MRS. JENNIFER L. BISHOP P.T.A. (NPI 1477788800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487491205 NPI number — RIVERSIDE PHYSICAL THERAPY & PELVIC HEALTH, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE PHYSICAL THERAPY & PELVIC HEALTH, S.C.
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:
1487491205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4440 HARTSTONE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLINGER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53086-9034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-627-2220
Provider Business Mailing Address Fax Number:
262-284-9511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 E GREEN BAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAUKVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53080-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-284-9510
Provider Business Practice Location Address Fax Number:
262-284-9511
Provider Enumeration Date:
07/09/2024

Additional Information

Authorized Official

Authorized Official Last Name:
OTT
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
PRESIDENT/PHYSICAL THERAPIST
Authorized Official Telephone Number:
262-627-2220

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com