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NPI Code Detail

MEDICARE: LITTLE STROKES SWIM ACADEMY LLC

MEDICARE: LITTLE STROKES SWIM ACADEMY LLC
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
1273Y00000XRehabilitation Hospital Unit

General Provider Information

NPI Number : 1568014322
Entity Type Code : Organization
Provider Name (Legal Business Name) : LITTLE STROKES SWIM ACADEMY LLC
Provider Business Mailing Address
First Line : 1029 QUINN DR
Second Line :
City : WAUNAKEE
State : WI
Zip : 53597-2502
Country : US
Telephone Number : 608-819-0134
Fax Number :
Provider Business Practice Location Address
First Line : 1029 QUINN DR
Second Line :
City : WAUNAKEE
State : WI
Zip : 53597-2502
Country : US
Telephone Number : 608-819-0134
Fax Number :
Authorized Official
Title or Position : OWNER
Name : WILLIAM MICHAEL TYGUM
Credential :
Telephone Number : 608-335-3297
Provider Enumeration Date : 07/11/2019
Last Update Date : 07/11/2019

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Directions to “LITTLE STROKES SWIM ACADEMY LLC ” Practice Location

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