Healthcare Provider Details

I. General information

NPI: 1871787093
Provider Name (Legal Business Name): ATHLETIC & THERAPEUTIC INSTITUTE OF MILWAUKEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E WISCONSIN AVE STE 500
MILWAUKEE WI
53202-4463
US

IV. Provider business mailing address

4947 PAYSPHERE CIR
CHICAGO IL
60674-0049
US

V. Phone/Fax

Practice location:
  • Phone: 414-831-1150
  • Fax: 414-272-9594
Mailing address:
  • Phone: 630-296-2222
  • Fax: 630-759-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WADE A MEYER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 630-296-2223