Provider Demographics
NPI:1366653412
Name:PRIORITY PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PRIORITY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAPITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-842-1700
Mailing Address - Street 1:1415 MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2646
Mailing Address - Country:US
Mailing Address - Phone:715-842-1700
Mailing Address - Fax:715-842-1744
Practice Address - Street 1:1415 MERRILL AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-842-1700
Practice Address - Fax:715-842-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1500051475147OtherWEA
WI36190200Medicaid
WI=========012OtherBLUE CROSS BLUE SHEILD
WI000081633Medicare PIN