Provider Demographics
NPI:1386763399
Name:TOMAH THERAPY CENTER, LLC
Entity type:Organization
Organization Name:TOMAH THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:OYLER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:608-372-0800
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-0825
Mailing Address - Country:US
Mailing Address - Phone:608-372-0800
Mailing Address - Fax:608-372-1940
Practice Address - Street 1:430 JULIE ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-2924
Practice Address - Country:US
Practice Address - Phone:608-372-0800
Practice Address - Fax:608-372-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41807500Medicaid
WI41807500Medicaid