Provider Demographics
NPI:1336835339
Name:CONNECTED CORE PHYSICAL THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:CONNECTED CORE PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEETERS GEBLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:920-428-3301
Mailing Address - Street 1:6 BELLAIRE CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5264
Mailing Address - Country:US
Mailing Address - Phone:920-428-3301
Mailing Address - Fax:
Practice Address - Street 1:6 BELLAIRE CT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5264
Practice Address - Country:US
Practice Address - Phone:920-428-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy