Organization
THEDA CARE PEABODY MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI MARIE RADISH MSPT (PHYSICAL THERAPIST)
(920) 225-7764
Entity
Organization
Contact information
Practice address
2600 S HERITAGE WOODS DR, APPLETON, WI 54915-1408
(920) 225-7764
Mailing address
W7409 REDHAWK DR, APPLETON, WI 54914-9153
(920) 757-0190
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
9771-24
WI
Other
Enumeration date
01/04/2007
Last updated
08/22/2020
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