Provider Demographics
NPI:1972864155
Name:NX LEVEL PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:NX LEVEL PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-349-9297
Mailing Address - Street 1:W229N1416 WESTWOOD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1309
Mailing Address - Country:US
Mailing Address - Phone:262-349-9297
Mailing Address - Fax:262-278-4062
Practice Address - Street 1:W229N1416 WESTWOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1309
Practice Address - Country:US
Practice Address - Phone:262-349-9297
Practice Address - Fax:262-278-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10389-24261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy