Provider Demographics
NPI:1225040926
Name:CEDARBURG PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:CEDARBURG PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOLDBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:262-375-2195
Mailing Address - Street 1:W63N541 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1917
Mailing Address - Country:US
Mailing Address - Phone:262-375-2195
Mailing Address - Fax:262-375-2273
Practice Address - Street 1:W63N541 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1917
Practice Address - Country:US
Practice Address - Phone:262-375-2195
Practice Address - Fax:262-375-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI86687Medicaid
WI86687Medicaid