| Fastback Physical Therapy Llc | |
|
3333 S Sunnyslope Rd Ste 103b New Berlin WI 53151-4504 | |
| (262) 853-8452 | |
| Not Available |
| Full Name | Fastback Physical Therapy Llc |
|---|---|
| Speciality | Physical Therapist |
| Location | 3333 S Sunnyslope Rd Ste 103b, New Berlin, Wisconsin |
| Authorized Official Name and Position | Michele Weninger (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2486019207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fastback Physical Therapy Llc 1773 Star Batt Dr Rochester Hills MI 48309-3708 Ph: () - | Fastback Physical Therapy Llc 3333 S Sunnyslope Rd Ste 103b New Berlin WI 53151-4504 Ph: (262) 853-8452 |
| NPI Number | 1104393982 |
|---|---|
| Provider Enumeration Date | 10/30/2018 |
| Last Update Date | 08/06/2024 |
| Certification Date | 08/06/2024 |
| Medicare PECOS PAC ID | 2466797782 |
|---|---|
| Medicare Enrollment ID | O20181214000642 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104393982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
| Provider Name | Patrick S Barron |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326071200 PECOS PAC ID: 2567621360 Enrollment ID: I20120314000748 |
| Provider Name | Samual T Marusic |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1881205854 PECOS PAC ID: 1850710328 Enrollment ID: I20201001003296 |
| Provider Name | Ashley Ziegler |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1972200186 PECOS PAC ID: 1153780366 Enrollment ID: I20230706002763 |
| Provider Name | Angela Giangiulio |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1386212447 PECOS PAC ID: 5799147823 Enrollment ID: I20230821004043 |
| Provider Name | Alexandria Dollhopf |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1932884277 PECOS PAC ID: 0345684338 Enrollment ID: I20240217000842 |
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