Organization
INNOVATIVE PHYSICAL THERAPY & WELLNESS, LLC
Active
Organization
INNOVATIVE PHYSICAL THERAPY & WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRISTA LARSON DPT (OWNER, DOCTOR OF PHYSICAL THERAPY)
(920) 770-4150
Entity
Organization
Contact information
Practice address
715 SUPERIOR RD STE 103, GREEN BAY, WI 54311-7595
(920) 770-4150
(920) 770-4149
Mailing address
715 SUPERIOR RD STE 103, GREEN BAY, WI 54311-7595
(920) 770-4150
(920) 770-4149
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
08/25/2022
Last updated
08/25/2022
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