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General NPI Number Information
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NPI Number | 1700146230
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Entity Type | Organization
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Legal Business Name | JOURNEY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 1551 S 108TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-4020
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Country | US
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Telephone | 414-475-9999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11327
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City | SHOREWOOD
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State | WI
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Zip | 53211-0327
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Country | US
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Telephone | 414-475-9999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT FREDIANI
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Credential |
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Telephone | 414-475-9999
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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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