Provider Demographics
NPI:1285682385
Name:SUSSEX FAMIILY PRACTICE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SUSSEX FAMIILY PRACTICE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-246-8009
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-0127
Mailing Address - Country:US
Mailing Address - Phone:262-246-8009
Mailing Address - Fax:262-246-4431
Practice Address - Street 1:N64W24086 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3002
Practice Address - Country:US
Practice Address - Phone:262-246-8009
Practice Address - Fax:262-246-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI82040Medicare ID - Type Unspecified