Provider Demographics
NPI:1417367509
Name:SPECIALIZED THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:SPECIALIZED THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLMERS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:414-778-1341
Mailing Address - Street 1:890 ELM GROVE RD STE 1-1
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2528
Mailing Address - Country:US
Mailing Address - Phone:414-778-1341
Mailing Address - Fax:262-794-3888
Practice Address - Street 1:890 ELM GROVE RD STE 1-1
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2528
Practice Address - Country:US
Practice Address - Phone:414-778-1341
Practice Address - Fax:262-794-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation