Provider Demographics
NPI:1801919493
Name:WISCONSIN THERAPISTS LTD.
Entity type:Organization
Organization Name:WISCONSIN THERAPISTS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOME
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:608-359-2677
Mailing Address - Street 1:635 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-1556
Mailing Address - Country:US
Mailing Address - Phone:608-299-8181
Mailing Address - Fax:608-299-8281
Practice Address - Street 1:2737 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2246
Practice Address - Country:US
Practice Address - Phone:608-299-8181
Practice Address - Fax:608-299-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014400225100000X
WI0977-026225X00000X
IL056.007747225X00000X
WI2282-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41220400Medicaid
WI41220400Medicaid
WI41220400Medicaid
WI=========019OtherBCBS ANTHUM WI.
WI41220400Medicaid