Provider Demographics
NPI:1700146230
Name:JOURNEY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:JOURNEY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-475-9999
Mailing Address - Street 1:PO BOX 11327
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-0327
Mailing Address - Country:US
Mailing Address - Phone:414-475-9999
Mailing Address - Fax:
Practice Address - Street 1:1551 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4020
Practice Address - Country:US
Practice Address - Phone:414-475-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy