MEDICARE: RSYD INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184380149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RSYD INCORPORATED

Provider Business Mailing Address
First Line	:	3855 N 51ST BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2303
Country	:	US
Telephone Number	:	141-440-6308
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 N 51ST BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2303
Country	:	US
Telephone Number	:	414-810-3440
Fax Number	:

Authorized Official
Title or Position	:	REHABILITATION SPECIALIST
Name	:	PAULA Y GREEN;LAW
Credential	:
Telephone Number	:	414-331-4826

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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