Provider Demographics
NPI:1558861302
Name:NISSENBAUM AND SCHLEUSNER PRO PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:NISSENBAUM AND SCHLEUSNER PRO PHYSICAL THERAPY LLC
Other - Org Name:PRO PHYSICAL THERAPY - MIDDLETON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB-BUFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-841-1290
Mailing Address - Street 1:6649 UNIVERSITY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3021
Mailing Address - Country:US
Mailing Address - Phone:608-841-1290
Mailing Address - Fax:608-841-1299
Practice Address - Street 1:6649 UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562
Practice Address - Country:US
Practice Address - Phone:608-413-0550
Practice Address - Fax:608-413-0552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NISSENBAUM AND SCHLEUSNER PRO PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-19
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty