Healthcare Provider Details

I. General information

NPI: 1891104030
Provider Name (Legal Business Name): ARYV OF TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 WOODGATE DRIVE
JANESVILLE WI
53546-9680
US

IV. Provider business mailing address

4425 WOODGATE DRIVE
JANESVILLE WI
53546-9680
US

V. Phone/Fax

Practice location:
  • Phone: 920-542-1040
  • Fax: 608-492-6544
Mailing address:
  • Phone: 608-750-1630
  • Fax: 608-492-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: KEVIN KNUTESON
Title or Position: CEO
Credential:
Phone: 608-750-1630