Impact Physical Therapy & Performance LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

IMPACT PHYSICAL THERAPY & PERFORMANCE LLC

Practice address

1155 Clarity Dr
Verona, WI 53593-9318

Phone

(608) 293-4508

NPI assigned

Sep 27, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Matthew Koester, PT, DPTNPI 1245889229

Title

Founding Owner

Phone

(608) 293-4508

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lifelong Range Of Motion LLC Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Koester, DPT

  • Physical Therapist
  • Middleton, WI
  • NPI 1245889229
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569542400000",
    "number": "1821649088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W4850 PEMBRIDGE TRL",
            "city": "MONROE",
            "state": "WI",
            "postal_code": "535668745",
            "telephone_number": "608-293-4508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 CLARITY DR",
            "city": "VERONA",
            "state": "WI",
            "postal_code": "535939318",
            "telephone_number": "608-293-4508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY & PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-27",
        "last_updated": "2019-09-27",
        "status": "A",
        "authorized_official_last_name": "KOESTER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "FOUNDING OWNER",
        "authorized_official_telephone_number": "608-293-4508",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245889229",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifelong Range Of Motion LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Yaole Hu
• Margo E Hubbard, PA-C
• Hannah K Huber
• Tami Sue Hunt, O.D.
• Sarah Hurd, COTA/L
• In the Moment Child and Family Therapy, LLC
• Infinite Relationships LLC
• Brittany Innes, OTR/L
• Sophia Gabrielle Izydor
• Ariele J Jackson

• Physical Therapy Clinic/Center in Verona, WI
• Providers in Verona, WI by specialty
• Physical Therapy Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.