Provider Demographics
NPI:1558758573
Name:PIKE CREEK ENTERPRISES, LLC
Entity Type:Organization
Organization Name:PIKE CREEK ENTERPRISES, LLC
Other - Org Name:CONNOLLY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, FAAOMPT
Authorized Official - Phone:262-945-0024
Mailing Address - Street 1:598 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1251
Mailing Address - Country:US
Mailing Address - Phone:262-763-7591
Mailing Address - Fax:
Practice Address - Street 1:598 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1251
Practice Address - Country:US
Practice Address - Phone:262-763-7591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5392024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy