Form & Fitness

NPI #1063612067 in Mequon, Wisconsin

Provider Information

NPI Number: 1063612067
Entity Type: Organization
Organization Name: Form & Fitness
Primary Specialty: Physical Therapist
Enumeration Date: Jul 19, 2007
Last Updated: Jul 19, 2007

Practice Location

Address: 11053 N PORT WASHINGTON RD
City: Mequon
State: Wisconsin
ZIP Code: 53092-5032
Phone: (262) 241-3449

Authorized Official

Name: MR. BEN QUIST, DPT
Title: PRESIDENT
Phone: (262) 241-3449

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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