Provider Demographics
NPI:1619674702
Name:FREEMAN LEICK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FREEMAN LEICK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:262-309-4870
Mailing Address - Street 1:285 N JANACEK RD STE C
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6102
Mailing Address - Country:US
Mailing Address - Phone:262-309-4870
Mailing Address - Fax:
Practice Address - Street 1:285 N JANACEK RD STE C
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6102
Practice Address - Country:US
Practice Address - Phone:262-309-4870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy