Provider Demographics
NPI:1952767451
Name:HOUGLUM PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HOUGLUM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOUGLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, ATC/L
Authorized Official - Phone:262-909-4903
Mailing Address - Street 1:1222 WASHINGTON CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2615
Mailing Address - Country:US
Mailing Address - Phone:847-251-1539
Mailing Address - Fax:847-251-1539
Practice Address - Street 1:1222 WASHINGTON CT
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2615
Practice Address - Country:US
Practice Address - Phone:847-251-1539
Practice Address - Fax:847-251-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy