Healthcare Provider Details

I. General information

NPI: 1619252236
Provider Name (Legal Business Name): ATHLETIC AND THERAPEUTIC INSTITUTE OF MILWAUKEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 N FARWELL AVE
MILWAUKEE WI
53211-4401
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 414-220-9084
  • Fax: 414-220-9082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LYNN MCGIVERN
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 630-296-2222