Provider Demographics
NPI:1053413567
Name:ONE-ON-ONE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ONE-ON-ONE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:414-640-2372
Mailing Address - Street 1:503 MINORS DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9413
Mailing Address - Country:US
Mailing Address - Phone:414-640-2372
Mailing Address - Fax:262-363-5227
Practice Address - Street 1:503 MINORS DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9413
Practice Address - Country:US
Practice Address - Phone:414-640-2372
Practice Address - Fax:262-363-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIPT 5600-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11231010OtherCAQH PROVIDER ID
WIPT 5600-024OtherPT LICENSE NUMBER
WI0007744470OtherAETNA ID
WI610442200OtherOWCP, US DEPT. OF LABOR
WI2128442OtherFIRST HEALTH ID
WI11231010OtherCAQH PROVIDER ID
WIDC6964Medicare PIN
WI0007744470OtherAETNA ID
WI610442200OtherOWCP, US DEPT. OF LABOR