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General NPI Number Information
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NPI Number | 1124354931
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Entity Type | Organization
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Legal Business Name | THERAPY WIZARDS CORP
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 3727 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53208-3182
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Country | US
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Telephone | 414-810-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 2713 ELIM AVE.
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City | ZION
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State | IL
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Zip | 60099-2640
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Country | US
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Telephone | 847-322-6551
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Fax | 800-364-0886
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Authorized Official
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Title or Position | OWNER
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Name | RONALD SAMANIEGO
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Credential | PT
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Telephone | 847-322-6551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 488612
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070014146
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1015624
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License Number State | WI
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