OrganizationActive
Innovative Physical Therapy & Wellness, LLC
NPI 1073232658 · Physical Therapy Clinic/Center · Green Bay, WI
Provider details
- NPI number
- 1073232658
- Entity type
- Organization
- Primary specialty
- Physical Therapy Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Trista Larson, Owner, Doctor of Physical Therapy(920) 770-4150
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(60/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
715 Superior Rd Ste 103
Green Bay, WI 54311-7595
Phone: (920) 770-4150
Fax: (920) 770-4149
Street-level locationGet directions
Mailing address
715 Superior Rd Ste 103
Green Bay, WI 54311-7595
Registry dates
- Enumerated
- 2022-08-25
- Last updated
- 2022-08-25
- Certified
- 2022-08-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.