Provider Demographics
NPI:1437309697
Name:PREMIER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAMN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-650-0348
Mailing Address - Street 1:2260 WREN LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7740
Mailing Address - Country:US
Mailing Address - Phone:262-650-0348
Mailing Address - Fax:262-650-0392
Practice Address - Street 1:4125 N 124TH ST
Practice Address - Street 2:STE A
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-1837
Practice Address - Country:US
Practice Address - Phone:262-650-0348
Practice Address - Fax:262-650-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4259024251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management