Provider Demographics
NPI:1427556588
Name:JOINTS IN MOTION MEDICAL, LLC
Entity Type:Organization
Organization Name:JOINTS IN MOTION MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-547-4276
Mailing Address - Street 1:1343 E WISCONSIN AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3741
Mailing Address - Country:US
Mailing Address - Phone:262-547-4276
Mailing Address - Fax:262-547-0512
Practice Address - Street 1:525 W. RIVERWOODS PARKWAY #120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:262-547-4276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOINTS IN MOTION MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41572000Medicaid