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General NPI Number Information
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NPI Number | 1548549397
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Entity Type | Organization
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Legal Business Name | PRESTIGE THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 1604 LEGEND HILL LN
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City | WAUKESHA
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State | WI
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Zip | 53189-8088
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Country | US
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Telephone | 262-880-4664
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Fax | 262-447-0850
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Provider Business Mailing Address
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Address Line | 1604 LEGEND HILL LN
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City | WAUKESHA
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State | WI
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Zip | 53189-8088
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Country | US
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Telephone | 262-880-4664
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Fax | 262-447-0850
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Authorized Official
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Title or Position | OWNER
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Name | MR. PRESTON BROWN
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Credential | PT
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Telephone | 262-880-4664
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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 | 10950-24
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License Number State | WI
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