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NPI Code Detail

MEDICARE: SPRINGBROOK WELLNESS LLC

MEDICARE: SPRINGBROOK WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist

General Provider Information

NPI Number : 1437679008
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPRINGBROOK WELLNESS LLC
Provider Business Mailing Address
First Line : 3715 80TH ST
Second Line :
City : KENOSHA
State : WI
Zip : 53142-4950
Country : US
Telephone Number : 262-358-1975
Fax Number :
Provider Business Practice Location Address
First Line : 3715 80TH ST
Second Line :
City : KENOSHA
State : WI
Zip : 53142-4950
Country : US
Telephone Number : 262-358-1975
Fax Number :
Authorized Official
Title or Position : OWNER/MASSAGE THERAPIST
Name : KRISTIN E NIEZE
Credential :
Telephone Number : 262-412-5727
Provider Enumeration Date : 06/23/2017
Last Update Date : 07/21/2022

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Directions to “SPRINGBROOK WELLNESS LLC ” Practice Location

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