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Organization
GREAT LAKES HEALTHCARE, INC.
Active
Organization
GREAT LAKES HEALTHCARE, INC.
Active
Other names
Preceptor Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
LEE JOHNSON (TREASURER)
(208) 401-1369
Entity
Organization
Contact information
Practice address
W175N11117 STONEWOOD DR STE 100, GERMANTOWN, WI 53022-6505
(208) 401-1369
Mailing address
W175N11117 STONEWOOD DR STE 100, GERMANTOWN, WI 53022-6505
(262) 293-3951
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
05/30/2019
Last updated
03/17/2021
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