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Organization
OCONTO PHYSICAL THERAPY, LLC
Active
Organization
OCONTO PHYSICAL THERAPY, LLC
Active
Other names
Haight Pain
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA L WILLETTE (BILLING MANAGER)
(920) 437-7246
Entity
Organization
Contact information
Practice address
300 N BROADWAY, SUITE 3C, GREEN BAY, WI 54303-2702
(920) 437-7246
(920) 437-1511
Mailing address
300 N BROADWAY, SUITE 3C, GREEN BAY, WI 54303-2702
(920) 437-7246
(920) 437-1511
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1934
WI
225100000X
Physical Therapist
2368
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40422000
—
WI
01
—
DA7771
MEDICARE RR
WI
Enumeration date
10/11/2005
Last updated
08/27/2014
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