Provider Demographics
NPI:1306863220
Name:THERAPY PLUS OF WISCONSIN LLC
Entity Type:Organization
Organization Name:THERAPY PLUS OF WISCONSIN LLC
Other - Org Name:THERAPY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:FREDIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-856-1888
Mailing Address - Street 1:PO BOX 11327
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-0327
Mailing Address - Country:US
Mailing Address - Phone:414-856-1888
Mailing Address - Fax:414-272-5779
Practice Address - Street 1:8619 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2919
Practice Address - Country:US
Practice Address - Phone:414-856-1888
Practice Address - Fax:414-272-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40440600Medicaid
WI40602700Medicaid
WI41044000Medicaid
WI36102100Medicaid
WI000280605Medicare PIN
WI000080605Medicare PIN
WI000180108Medicare PIN
WI41044000Medicaid
WI000080108Medicare PIN
WI40440600Medicaid
WI36102100Medicaid
WI0000580605Medicare PIN