Provider Demographics
NPI:1386733517
Name:ANATOMY SHOP PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ANATOMY SHOP PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-363-3268
Mailing Address - Street 1:111 ATKINSON ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1439
Mailing Address - Country:US
Mailing Address - Phone:262-363-3268
Mailing Address - Fax:262-363-3269
Practice Address - Street 1:111 ATKINSON ST UNIT 2
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1439
Practice Address - Country:US
Practice Address - Phone:262-363-3268
Practice Address - Fax:262-363-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40425200Medicaid
WI40425200Medicaid