Provider Demographics
NPI:1891889093
Name:PRO STEP PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PRO STEP PHYSICAL THERAPY LLC
Other - Org Name:THERAPY PLUS OF WISCONSIN LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:FREDIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-791-0813
Mailing Address - Street 1:8619 S. HOWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154
Mailing Address - Country:US
Mailing Address - Phone:414-856-1888
Mailing Address - Fax:414-856-1891
Practice Address - Street 1:10233 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3911
Practice Address - Country:US
Practice Address - Phone:414-791-0813
Practice Address - Fax:262-364-2248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPY PLUS OF WISCONSIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40602700Medicaid
WI9560-024OtherPHYSICAL THERAPY LICENSE
WI1891889093OtherPRO STEP NPIN NUMBER
WI40541400Medicaid
WI36102100Medicaid
WI40440600Medicaid
WI41044000Medicaid
WI41044000Medicaid
WI000280605Medicare PIN
WI000180108Medicare PIN
WI40541400Medicaid
WI40440600Medicaid
WI00080345Medicare PIN