Organization
IMPACT PHYSICAL THERAPY & PERFORMANCE LLC
Active
Other names
Lifelong Range Of Motion LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW KOESTER PT, DPT (FOUNDING OWNER)
(608) 293-4508
Entity
Organization
Contact information
Practice address
1155 CLARITY DR, VERONA, WI 53593-9318
(608) 293-4508
Mailing address
W4850 PEMBRIDGE TRL, MONROE, WI 53566-8745
(608) 293-4508
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245889229
—
WI
Enumeration date
09/27/2019
Last updated
09/27/2019
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