Healthcare Provider Details

I. General information

NPI: 1164912689
Provider Name (Legal Business Name): LIVINGWELL N-HOME THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 30TH AVE STE B1
KENOSHA WI
53144-1957
US

IV. Provider business mailing address

600 52ND ST STE 240
KENOSHA WI
53140-3423
US

V. Phone/Fax

Practice location:
  • Phone: 262-909-2874
  • Fax: 262-652-6305
Mailing address:
  • Phone: 262-925-5004
  • Fax: 262-925-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARMELO TENUTA
Title or Position: PRESIDENT CEO
Credential:
Phone: 262-925-5000