Provider Demographics
NPI:1689456824
Name:WALZ PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:WALZ PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:WALZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:608-780-0352
Mailing Address - Street 1:1900 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2027
Mailing Address - Country:US
Mailing Address - Phone:608-780-0352
Mailing Address - Fax:
Practice Address - Street 1:N5560 COUNTY ROAD ZM
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-1300
Practice Address - Country:US
Practice Address - Phone:608-779-5323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy