Provider Demographics
NPI:1649563115
Name:MIDWEST PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:MIDWEST PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA-LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWEFEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:262-248-6855
Mailing Address - Street 1:921 PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4620
Mailing Address - Country:US
Mailing Address - Phone:262-248-6855
Mailing Address - Fax:262-248-6840
Practice Address - Street 1:921 PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4620
Practice Address - Country:US
Practice Address - Phone:262-248-6855
Practice Address - Fax:262-248-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation