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General NPI Number Information
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NPI Number | 1962199307
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Entity Type | Organization
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Legal Business Name | ARETAS02, LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 5764 S 108TH ST
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City | HALES CORNERS
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State | WI
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Zip | 53130-1947
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Country | US
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Telephone | 480-543-8394
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Fax |
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Provider Business Mailing Address
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Address Line | 5764 S 108TH ST
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City | HALES CORNERS
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State | WI
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Zip | 53130-1947
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVIN ROBERT ECKERT
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Credential | DPT
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Telephone | 480-543-8394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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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 |
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License Number State |
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