Healthcare Provider Details

I. General information

NPI: 1891889093
Provider Name (Legal Business Name): PRO STEP PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10233 W GREENFIELD AVE
MILWAUKEE WI
53214-3911
US

IV. Provider business mailing address

8619 S. HOWELL AVENUE
OAK CREEK WI
53154
US

V. Phone/Fax

Practice location:
  • Phone: 414-791-0813
  • Fax: 262-364-2248
Mailing address:
  • Phone: 414-856-1888
  • Fax: 414-856-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT F FREDIANI
Title or Position: MEMBER
Credential:
Phone: 414-791-0813