Provider Demographics
NPI:1619144417
Name:AMERICAN WAY THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:AMERICAN WAY THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ADRIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-332-1511
Mailing Address - Street 1:2611 NORTH LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-332-1511
Mailing Address - Fax:
Practice Address - Street 1:2611 NORTH LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-332-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41204500Medicaid