Provider Demographics
NPI:1861495145
Name:FRUITION THERAPY, LTD
Entity Type:Organization
Organization Name:FRUITION THERAPY, LTD
Other - Org Name:HEALING HANDS PHYSICAL THERAPY AND MASSAGE, LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PT/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-725-1664
Mailing Address - Street 1:N8123 ROSE TER
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-2474
Mailing Address - Country:US
Mailing Address - Phone:262-723-2711
Mailing Address - Fax:
Practice Address - Street 1:N8123 ROSE TER
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-2474
Practice Address - Country:US
Practice Address - Phone:262-723-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9598-024208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40423500Medicaid
WI40423500Medicaid