Provider Demographics
NPI:1366527228
Name:HEAD 2 TOE PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:HEAD 2 TOE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:715-453-7600
Mailing Address - Street 1:202 W MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-2215
Mailing Address - Country:US
Mailing Address - Phone:715-453-7600
Mailing Address - Fax:715-453-6403
Practice Address - Street 1:202 W MOHAWK DR
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-2215
Practice Address - Country:US
Practice Address - Phone:715-453-7600
Practice Address - Fax:715-453-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6491-024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40336300Medicaid