Provider Demographics
NPI:1639408396
Name:VISITING PHYSICAL THERAPISTS, LLC
Entity Type:Organization
Organization Name:VISITING PHYSICAL THERAPISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BERGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:414-940-7278
Mailing Address - Street 1:PO BOX 371031
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53237-2131
Mailing Address - Country:US
Mailing Address - Phone:414-940-7278
Mailing Address - Fax:414-769-1808
Practice Address - Street 1:6072 S MEADOW CT
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-3410
Practice Address - Country:US
Practice Address - Phone:414-940-7278
Practice Address - Fax:414-769-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty