Provider Demographics
NPI:1548569692
Name:STAY STRONG THERAPIES LLC
Entity Type:Organization
Organization Name:STAY STRONG THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:262-367-3700
Mailing Address - Street 1:21140 W CAPITOL DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2953
Mailing Address - Country:US
Mailing Address - Phone:262-754-1650
Mailing Address - Fax:262-754-0877
Practice Address - Street 1:21140 W CAPITOL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53072-2953
Practice Address - Country:US
Practice Address - Phone:262-754-1650
Practice Address - Fax:262-754-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2435-26261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2435-26OtherOT LICENSE