Provider Demographics
NPI:1083328785
Name:CLEAR LAKE PHYSICAL THERAPY AND REHAB SPECIALISTS LLC
Entity Type:Organization
Organization Name:CLEAR LAKE PHYSICAL THERAPY AND REHAB SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWEN
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-263-4103
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54005-8905
Mailing Address - Country:US
Mailing Address - Phone:715-263-4103
Mailing Address - Fax:
Practice Address - Street 1:224 RIVER AVE S
Practice Address - Street 2:
Practice Address - City:PRAIRIE FARM
Practice Address - State:WI
Practice Address - Zip Code:54762-9786
Practice Address - Country:US
Practice Address - Phone:715-263-4103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy