SOUTHERN LAKES PHYSICAL THERAPY (NPI# 1699965525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699965525 |
| Entity Type | Organization |
| Organization Name | SOUTHERN LAKES PHYSICAL THERAPY |
| Practice Address |
2121 S Kinnickinnic Ave Suite Three Milwaukee WI 53207-1364 |
| Mailing Address |
2121 S Kinnickinnic Ave Ste 3 Milwaukee WI 53207-1368 |
| Practice Telephone | 4147440707 |
| Mailing Telephone | 4147440707 |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2019-10-11 |
| Authorized Official Name | DR. WILLIAM LOIS (OWNER/PRESIDENT) |
| Authorized Official Telephone | 4147440707 |
| Authorized Official Credential | DPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
10406024 | WI | Ambulatory Health Care Facilities |
| Street Address |
2121 S KINNICKINNIC AVE SUITE THREE |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53207-1364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972632842 | William Lois | Specialist | 2121 S Kinnickinnic Ave, Suite 3, Milwaukee, WI 53207-1364 | 2007-03-05 |
| 1508312588 | Forefront Dermatology, S.c. | Dermatology | 2121 S Kinnickinnic Ave, #4, Milwaukee, WI 53207 | 2016-08-30 |
| 1467860650 | Amber Anderson | Physical Therapist | 2121 S Kinnickinnic Ave, Ste 3, Milwaukee, WI 53207-1364 | 2014-07-31 |
| 1326374703 | Joseph Plicka | Physical Therapy Assistant | 2121 S Kinnickinnic Ave, Suite 3, Milwaukee, WI 53207-1364 | 2009-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497304117 | Diane Wisch | Technician | 3602 S. 4th, Mil, WI 53207 | 2019-09-05 |
| 1811384464 | Megan O Bedolla | Emergency Medicine | 2338 E Ohio Ave, Milwaukee, WI 53207 | 2015-04-21 |
| 1255677563 | Jon Arthur Toppen | Counselor | 2637 S Fulton St, Milwaukee, WI 53207 | 2012-12-14 |
| 1720316730 | Paula Maria Ortega Flores | Massage Therapist | 2121 South Kinnickinnic Ave, Suite 3, Milwaukee, WI 53207 | 2009-12-02 |
| 1306087127 | Theron Mills | Counselor | 3073 S. Chase Ave., Suite 326, Milwaukee, WI 53207 | 2009-03-09 |
| 1841438769 | Counseling & Transition Center Inc | Clinic/Center | 3073 S. Chase Ave, Suite 326, Milwaukee, WI 53207 | 2009-01-30 |
| 1679727812 | Well-rounded, LLC | Clinic/Center | 2455 S. Howell Ave., Milwaukee, WI 53207 | 2008-11-14 |
| 1316154024 | Christian T. Harteau | Student in an Organized Health Care Education/Training Program | 3174 S Howell Ave, Milwaukee, WI 53207 | 2007-05-16 |
| 1316008303 | Thomas Fisher | Clinical Neuropsychologist | 2419 S. Lenox Street, Milwaukee, WI 53207 | 2006-12-13 |
| 1750470811 | David Alan Duter | Technician, Other | Uscg Sector Lake Michigan/hs Div, 2420 S. Lincoln Memorial Dr., Milwaukee, WI 53207 | 2006-10-12 |
| Find all providers in zip 53207 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861979445 | Summit Wellness, Inc. | Clinic/Center | 301 E Reservoir Ave Ste 1, Milwaukee, WI 53212-3743 | 2018-07-25 |
| 1083101117 | Kinetic Sports Medicine and Performance LLC | Clinic/Center | 665 S 72nd St, Milwaukee, WI 53214-1558 | 2018-04-14 |
| 1548511975 | Be Well Therapeutic Massage, LLC | Clinic/Center | 2834 N 62nd St, Milwaukee, WI 53210-2117 | 2012-09-25 |
| 1750530812 | A Step Ahead Physical Therapy Services | Clinic/Center | 2915 S Kinnickinnic Ave, Milwaukee, WI 53207-2518 | 2008-09-15 |
| 1881643005 | Kerk Physical Therapy Specialists Sc | Clinic/Center | 807 N Jefferson St, Milwaukee, WI 53202 | 2006-05-06 |
| 1245238906 | United Therapy Services, Inc. | Clinic/Center | 3209 S Lake Dr, Milwaukee, WI 53235-3712 | 2005-07-07 |
| 1912565771 | Cameo Nursing Home, LLC | Clinic/Center | 5790 S 27th St, Milwaukee, WI 53221-4129 | 2019-06-05 |
| 1255834800 | Occupational Heath Centers of The Southwest Pa | Clinic/Center | 11414 W Park Pl Ste 100, Milwaukee, WI 53224-3500 | 2018-03-09 |
| 1578015889 | Mindful Matters Wellness, LLC | Clinic/Center | 1845 N Farwell Ave, Ste 200, Milwaukee, WI 53202-1793 | 2016-11-03 |
| 1508258526 | Quad Medical | Clinic/Center | 633 E Mason St, Milwaukee, WI 53202-3813 | 2015-02-27 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.