Provider Demographics
NPI:1710323563
Name:PHYSICALLY CORRECT PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:PHYSICALLY CORRECT PHYSICAL THERAPY SERVICES, 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 370081
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53237-1181
Mailing Address - Country:US
Mailing Address - Phone:414-940-7278
Mailing Address - Fax:414-235-4884
Practice Address - Street 1:5889 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2817
Practice Address - Country:US
Practice Address - Phone:414-940-7278
Practice Address - Fax:414-235-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5058-024246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty