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Organization
SPINE & ORTHOPEDIC PHYSICAL THERAPY
Active
Organization
SPINE & ORTHOPEDIC PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLALEKAN LUKMAN GANIYU P.T. (OWNER OF PRACTICE AND P.T.)
(608) 368-9783
Entity
Organization
Contact information
Practice address
2958 PRAIRIE AVE STE B, BELOIT, WI 53511-1825
(608) 368-9783
Mailing address
2958 PRAIRIE AVE STE B, BELOIT, WI 53511-1825
(608) 368-9783
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5648-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40403900
—
WI
01
—
540545994009
BLUE CROSS NUMBER
WI
Enumeration date
03/27/2007
Last updated
08/22/2020
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