Provider Demographics
NPI:1750573150
Name:ADVANCED ORTHOPAEDIC PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ADVANCED ORTHOPAEDIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:CALLEN
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, MTC
Authorized Official - Phone:920-242-1122
Mailing Address - Street 1:1212 MEMORIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2247
Mailing Address - Country:US
Mailing Address - Phone:920-652-9554
Mailing Address - Fax:920-652-9556
Practice Address - Street 1:1212 MEMORIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2247
Practice Address - Country:US
Practice Address - Phone:920-652-9554
Practice Address - Fax:920-652-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty