Provider Demographics
NPI:1497386270
Name:OROSCO, JOE (LMT)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:OROSCO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MONROE ST STE 368
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2059
Mailing Address - Country:US
Mailing Address - Phone:608-852-5416
Mailing Address - Fax:
Practice Address - Street 1:1930 MONROE ST STE 368
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2059
Practice Address - Country:US
Practice Address - Phone:608-852-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13189-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist