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Organization
PROFECTUS PHYSICAL THERAPY LLC
Active
Organization
PROFECTUS PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARREN LOUIS NELSON DPT (OWNER)
(262) 551-7946
Entity
Organization
Contact information
Practice address
6123 GREEN BAY RD STE 140, KENOSHA, WI 53142-2927
(262) 653-9208
Mailing address
6123 GREEN BAY RD STE 140, KENOSHA, WI 53142-2927
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11955-024
WI
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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