# PREMIER PHYSICAL MEDICINE AND WELLNESS CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104913623
- **Authorized official:** JAMES E MULLEN M.D. (OWNER)
- **Authorized official phone:** (715) 356-9999

## Contact information

- **Practice address:** 1446 1ST AVE, WOODRUFF, WI 54568-9149
- **Practice address phone:** (715) 356-9999
- **Practice address fax:** (715) 356-9894
- **Mailing address:** PO BOX 1550, WOODRUFF, WI 54568-1550
- **Mailing address phone:** (715) 356-9999
- **Mailing address fax:** (715) 356-9894

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 33657 | WI | Yes |

## Other

- **Enumeration date:** 10/06/2006
- **Last updated:** 01/08/2009