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NPI Code Detail

MEDICARE: ATHLETIC AND THERAPEUTIC INSTITUTE OF MILWAUKEE, LLC

MEDICARE: ATHLETIC AND THERAPEUTIC INSTITUTE OF 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
1225X00000XOccupational Therapist
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1619252236
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATHLETIC AND THERAPEUTIC INSTITUTE OF MILWAUKEE, LLC
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2330 N FARWELL AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-4401
Country : US
Telephone Number : 414-220-9084
Fax Number : 414-220-9082
Authorized Official
Title or Position : CHIEF COMPLIANCE OFFICER
Name : LYNN MCGIVERN
Credential :
Telephone Number : 630-296-2222
Provider Enumeration Date : 10/14/2011
Last Update Date : 03/22/2012

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