Healthcare Provider Details

I. General information

NPI: 1548569692
Provider Name (Legal Business Name): STAY STRONG THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21140 W CAPITOL DR SUITE 4
BROOKFIELD WI
53072-2953
US

IV. Provider business mailing address

21140 W CAPITOL DR SUITE 4
BROOKFIELD WI
53072-2953
US

V. Phone/Fax

Practice location:
  • Phone: 262-754-1650
  • Fax: 262-754-0877
Mailing address:
  • Phone: 262-754-1650
  • Fax: 262-754-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number2435-26
License Number StateWI

VIII. Authorized Official

Name: VICTORIA MAGNAN
Title or Position: OWNER/PRESIDENT
Credential: OTR
Phone: 262-367-3700