Provider Demographics
NPI:1386679900
Name:ORLANU THERAPIES -THE MYOFASCIAL RELEASE CENTER OF MILWAUKEE, S.C.
Entity Type:Organization
Organization Name:ORLANU THERAPIES -THE MYOFASCIAL RELEASE CENTER OF MILWAUKEE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROZANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-241-7887
Mailing Address - Street 1:6789 N GREEN BAY AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3472
Mailing Address - Country:US
Mailing Address - Phone:262-241-7887
Mailing Address - Fax:262-241-7884
Practice Address - Street 1:6789 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3472
Practice Address - Country:US
Practice Address - Phone:262-241-7887
Practice Address - Fax:262-241-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========010OtherBLUE CROSS
=========010OtherBLUE CROSS