Organization
FIVE CORNERS PHYSICAL THERAPY S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY JOHN PROVENCHER PT (PRESIDENT)
(262) 377-8350
Entity
Organization
Contact information
Practice address
7269 STATE ROAD 60, SUITE 1, CEDARBURG, WI 53012-9702
(262) 377-8350
(262) 377-8390
Mailing address
7269 STATE ROAD 60, SUITE 1, CEDARBURG, WI 53012-9702
(262) 377-8350
(262) 377-8390
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
4146-024
WI
235Z00000X
Speech-Language Pathologist
Primary
1504-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40302100
—
WI
Enumeration date
01/31/2007
Last updated
09/11/2025
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