Provider Demographics
NPI:1568014322
Name:LITTLE STROKES SWIM ACADEMY LLC
Entity Type:Organization
Organization Name:LITTLE STROKES SWIM ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TYGUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-335-3297
Mailing Address - Street 1:1029 QUINN DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2502
Mailing Address - Country:US
Mailing Address - Phone:608-819-0134
Mailing Address - Fax:
Practice Address - Street 1:1029 QUINN DR
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2502
Practice Address - Country:US
Practice Address - Phone:608-819-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit