Healthcare Provider Details

I. General information

NPI: 1538256458
Provider Name (Legal Business Name): ELLEFSON THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 SUMMIT AVE STE 201
WAUKESHA WI
53188-3200
US

IV. Provider business mailing address

1425 SUMMIT AVE STE 201
WAUKESHA WI
53188-3200
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-1112
  • Fax: 262-542-7476
Mailing address:
  • Phone: 262-542-1112
  • Fax: 262-542-7476

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: MR. CARMELO D. TENUTA
Title or Position: PRESDENT/CEO
Credential: PT
Phone: 262-657-0222