IMPACT PHYSICAL THERAPY & PERFORMANCE LLC (NPI# 1821649088) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821649088 |
| Entity Type | Organization |
| Organization Name | IMPACT PHYSICAL THERAPY & PERFORMANCE LLC |
| Practice Address |
1155 Clarity Dr Verona WI 53593-9318 |
| Mailing Address |
W4850 Pembridge Trl Monroe WI 53566-8745 |
| Practice Telephone | 6082934508 |
| Mailing Telephone | 6082934508 |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2019-09-27 |
| Authorized Official Name | DR. MATTHEW KOESTER (FOUNDING OWNER) |
| Authorized Official Telephone | 6082934508 |
| Authorized Official Credential | PT, DPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1245889229 | 05 |
| Other Name | Type Code |
|---|---|
| Lifelong Range Of Motion LLC | Former Legal Business Name - Organization |
| Street Address |
1155 CLARITY DR |
| City | VERONA |
| State | WI |
| Zip Code | 53593-9318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609385467 | Tracy D. Pollack | Physical Therapist | 1049 North Edge Trail, Verona, WI 53593 | 2017-09-25 |
| 1851748115 | Jonna L Bier | Physical Therapy Assistant | 1049 N. Edge Trail, Verona, WI 53593 | 2016-05-17 |
| 1730451162 | Ultimate Performance Therapy, LLC | Physical Therapist | 403 Venture Ct, Suite 2, Verona, WI 53593 | 2012-02-01 |
| 1417246372 | Hammes Family Chiropractic LLC | Chiropractor | 1029 North Edge Trail, Verona, WI 53593 | 2011-03-31 |
| 1457678120 | Danielle Marie Waite | Licensed Practical Nurse | 606 Green Meadow Dr., Verona, WI 53593 | 2010-04-21 |
| 1316113418 | Linda T Hofstetter | Occupational Therapist | 720 Arbor Vitae Pl, Verona, WI 53593 | 2008-05-08 |
| 1902070758 | Judith F. Koeppl | Counselor | 4123 Monona Drive, Madison, WI 53593 | 2008-04-14 |
| 1881885408 | Carolyn J Moynihan | Marriage & Family Therapist | 8283 N Riley Rd, Verona, WI 53593 | 2007-08-08 |
| 1194810515 | Selma Herbst | Social Worker | 3657 Vickiann St, Verona, WI 53593 | 2006-10-03 |
| 1295830529 | Daniel Joseph Wadzinski | Dentist | 109 East Verona Avenue, Verona, WI 53593 | 2006-09-13 |
| Find all providers in zip 53593 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184286932 | Capitol Physical Therapy Specialists LLC | Clinic/Center | 416 E Verona Ave, Verona, WI 53593-1227 | 2019-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093313074 | Byond Physical Therapy, LLC | Clinic/Center | 11320 W Forest Home Ave, Franklin, WI 53132-1401 | 2020-10-13 |
| 1568078780 | Streamline Physical Therapy | Clinic/Center | 5806 Crabapple Ln, Madison, WI 53711-3437 | 2020-09-22 |
| 1790311199 | Exos Wi LLC | Clinic/Center | 7044 S Ballpark Dr Ste 300, Franklin, WI 53132-6910 | 2020-03-17 |
| 1831735885 | Garvey Physical Therapy & Wellness LLC | Clinic/Center | 417 Maple Ct, Campbellsport, WI 53010-3531 | 2019-11-25 |
| 1427605146 | Peak Endurance | Clinic/Center | 15 N Butler St, Madison, WI 53703-4237 | 2019-08-19 |
| 1558917617 | Quad/med, LLC | Clinic/Center | N61 W23044 Harry's Way, Sussex, WI 53089 | 2019-08-14 |
| 1619521267 | Space To Be Well, LLC | Clinic/Center | 1091 Sutherland Ave, River Falls, WI 54022-7509 | 2019-07-31 |
| 1346894656 | Cornerstone Physical Therapy, LLC | Clinic/Center | 2829 County Highway I Ste 3, Chippewa Falls, WI 54729-2678 | 2019-07-25 |
| 1619437514 | Resilience Rx LLC | Clinic/Center | 4708 Graywood Ct Apt 3, Nashotah, WI 53058-9688 | 2019-03-25 |
| 1720557135 | Wisconsin Chronic Pain Physical Therapy, Inc | Clinic/Center | 2500 N Mayfair Rd Ste 300, Wauwatosa, WI 53226-1415 | 2018-11-14 |
| Find all providers with the same taxonomy | ||||
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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.