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NPI Code Detail

MEDICARE: ETM MILWAUKEE LLC

MEDICARE: ETM MILWAUKEE 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 : 1447551411
Entity Type Code : Organization
Provider Name (Legal Business Name) : ETM MILWAUKEE LLC
Provider Business Mailing Address
First Line : 312 E SILVER SPRING DR
Second Line :
City : WHITEFISH BAY
State : WI
Zip : 53217-5221
Country : US
Telephone Number : 414-332-3260
Fax Number : 262-364-2325
Provider Business Practice Location Address
First Line : 312 E SILVER SPRING DR
Second Line :
City : WHITEFISH BAY
State : WI
Zip : 53217-5221
Country : US
Telephone Number : 414-332-3260
Fax Number : 262-364-2325
Authorized Official
Title or Position : OWNER
Name : AIMEE MATCHETTE
Credential :
Telephone Number : 414-332-3260
Provider Enumeration Date : 11/08/2010
Last Update Date : 11/08/2010

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Directions to “ETM MILWAUKEE LLC ” Practice Location

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