Organization
FORM & FITNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BEN QUIST DPT (PRESIDENT)
(262) 241-3449
Entity
Organization
Contact information
Practice address
11053 N PORT WASHINGTON RD, MEQUON, WI 53092-5032
(262) 241-3449
(262) 241-5229
Mailing address
11053 N PORT WASHINGTON RD, MEQUON, WI 53092-5032
(262) 241-3449
(262) 241-5229
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/19/2007
Last updated
07/19/2007
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