Provider Demographics
NPI:1497485791
Name:ADAPT PHYSICAL THERAPY & FITNESS LLC
Entity Type:Organization
Organization Name:ADAPT PHYSICAL THERAPY & FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GRABOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:715-252-8520
Mailing Address - Street 1:810 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2140
Mailing Address - Country:US
Mailing Address - Phone:715-252-8520
Mailing Address - Fax:
Practice Address - Street 1:2275 RILEY RD STE 3
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-1579
Practice Address - Country:US
Practice Address - Phone:715-252-8520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy