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NPI Code Detail

MEDICARE: BRIDGEWAY INDEPENDENT LIVING DESIGNS, LLC

MEDICARE: BRIDGEWAY INDEPENDENT LIVING DESIGNS, 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
1332BC3200XCustomized Equipment (DME)

General Provider Information

NPI Number : 1770882128
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIDGEWAY INDEPENDENT LIVING DESIGNS, LLC
Provider Business Mailing Address
First Line : 2738 N 74TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53210-1008
Country : US
Telephone Number : 262-671-2032
Fax Number : 888-217-9371
Provider Business Practice Location Address
First Line : 2738 N 74TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53210-1008
Country : US
Telephone Number : 262-671-2032
Fax Number : 888-217-9371
Authorized Official
Title or Position : OWNER
Name : MR. ROBERT HORKHEIMER
Credential : PT
Telephone Number : 262-671-2032
Provider Enumeration Date : 03/24/2011
Last Update Date : 03/24/2011

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Directions to “BRIDGEWAY INDEPENDENT LIVING DESIGNS, LLC ” Practice Location

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