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General NPI Number Information
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NPI Number | 1255386454
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Entity Type | Organization
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Legal Business Name | VITA PHYSICAL THERAPY SC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 451 E ERIE ST
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City | MILWAUKEE
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State | WI
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Zip | 53202-6159
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Country | US
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Telephone | 414-272-8482
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Fax | 414-272-2880
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Provider Business Mailing Address
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Address Line | 451 E ERIE ST
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City | MILWAUKEE
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State | WI
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Zip | 53202-6159
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Country | US
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Telephone | 414-272-8482
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Fax | 414-272-2880
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | BERIT KRISTENSEN GEORGEOFF
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Credential |
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Telephone | 414-272-8482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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