Healthcare Provider Details

I. General information

NPI: 1891952974
Provider Name (Legal Business Name): JOSHUA K GREENHECK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2008
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 S 16TH ST
MILWAUKEE WI
53215-4526
US

IV. Provider business mailing address

11018 W GODSELL AVE
HALES CORNERS WI
53130-1857
US

V. Phone/Fax

Practice location:
  • Phone: 414-647-7422
  • Fax:
Mailing address:
  • Phone: 414-647-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3103024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: