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General NPI Number Information
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NPI Number | 1073718771
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Entity Type | Organization
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Legal Business Name | LJN THERAPY, SC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 1404 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53233-2238
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Country | US
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Telephone | 414-288-1757
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 N 114TH ST
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City | WAUWATOSA
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State | WI
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Zip | 53226-1225
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Country | US
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Telephone | 414-453-0135
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY JOHN NOSSE
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Credential | PT
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Telephone | 414-453-0135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1246
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License Number State | WI
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