MEDICARE: JOURNEY PHYSICAL THERAPY 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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1700146230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 11327
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-0327
Country	:	US
Telephone Number	:	414-475-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 S 108TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4020
Country	:	US
Telephone Number	:	414-475-9999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT FREDIANI
Credential	:
Telephone Number	:	414-475-9999

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	05/17/2012

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