Organization
FORWARD PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN WELLENKOTTER (CO-OWNER)
(920) 265-6192
Entity
Organization
Contact information
Practice address
102 W FULTON ST, EDGERTON, WI 53534-1839
(920) 265-6192
Mailing address
102 W FULTON ST, EDGERTON, WI 53534-1839
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100059717
—
WI
05
—
1649610809
—
WI
Enumeration date
01/20/2019
Last updated
03/06/2026
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