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Organization
THERAPEUTIC ADVANTAGE LLC
Active
Organization
THERAPEUTIC ADVANTAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY STREETER PT (PHYSICAL THERAPIST, OWNER)
(920) 579-5168
Entity
Organization
Contact information
Practice address
W8645 HANNA LN, OAKFIELD, WI 53065-9546
(920) 979-6503
(920) 479-2991
Mailing address
PO BOX 1095, FOND DU LAC, WI 54936-1095
(920) 579-5168
(920) 479-2991
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790802684
NPI
—
Enumeration date
05/03/2022
Last updated
05/03/2022
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