Provider Demographics
NPI:1114379310
Name:EAST MEETS WEST THERAPEUTICS SC
Entity Type:Organization
Organization Name:EAST MEETS WEST THERAPEUTICS SC
Other - Org Name:EAST MEETS WEST THERAPEUTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, LAC
Authorized Official - Phone:847-226-8358
Mailing Address - Street 1:136 N MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1606
Mailing Address - Country:US
Mailing Address - Phone:847-226-8358
Mailing Address - Fax:262-292-1221
Practice Address - Street 1:136 N MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1606
Practice Address - Country:US
Practice Address - Phone:847-226-8358
Practice Address - Fax:262-292-1221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHALOM EX-IMPORT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI838261QH0100X
WI13342261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service