Provider Demographics
NPI:1508037268
Name:THE PHYSICAL THERAPY CENTER, SC
Entity Type:Organization
Organization Name:THE PHYSICAL THERAPY CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-483-9221
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:LUCK
Mailing Address - State:WI
Mailing Address - Zip Code:54853-0561
Mailing Address - Country:US
Mailing Address - Phone:715-472-8120
Mailing Address - Fax:
Practice Address - Street 1:210 W BUTTERNUT
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-0561
Practice Address - Country:US
Practice Address - Phone:715-472-8120
Practice Address - Fax:715-472-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40423600Medicaid