Provider Demographics
NPI:1043573991
Name:ALIGN PHYSICAL THERAPY ,LLC
Entity Type:Organization
Organization Name:ALIGN PHYSICAL THERAPY ,LLC
Other - Org Name:PAMELA L. WEBER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-638-2244
Mailing Address - Street 1:10767 NYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6484
Mailing Address - Country:US
Mailing Address - Phone:715-638-2244
Mailing Address - Fax:715-638-2368
Practice Address - Street 1:10767 NYMAN AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6484
Practice Address - Country:US
Practice Address - Phone:715-638-2244
Practice Address - Fax:715-638-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3564-24261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40378000Medicaid