Provider Demographics
NPI:1871985226
Name:MILWAUKEE SPORTS THERAPY
Entity type:Organization
Organization Name:MILWAUKEE SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-643-4027
Mailing Address - Street 1:2323 N MAYFAIR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1506
Mailing Address - Country:US
Mailing Address - Phone:414-384-6700
Mailing Address - Fax:414-727-1058
Practice Address - Street 1:3111 W RAWSON AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8890
Practice Address - Country:US
Practice Address - Phone:414-325-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC SURGEONS OF WISCONSIN SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy