Provider Demographics
NPI:1558063057
Name:PRO-ACTIVE PHYSICAL THERAPY, S.C.
Entity Type:Organization
Organization Name:PRO-ACTIVE PHYSICAL THERAPY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/P.T.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:262-939-5237
Mailing Address - Street 1:W4076 FREDONIA KOHLER RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53021
Mailing Address - Country:US
Mailing Address - Phone:262-939-5237
Mailing Address - Fax:
Practice Address - Street 1:W4076 FREDONIA KOHLER RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:WI
Practice Address - Zip Code:53021
Practice Address - Country:US
Practice Address - Phone:262-939-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty