# SB PHYSIATRY CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265242762
- **Authorized official:** SOLIVEN C BAUTISTA MD (PRESIDENT/OWNER)
- **Authorized official phone:** (414) 732-1503

## Contact information

- **Practice address:** 201 N MAYFAIR RD FL 4, MILWAUKEE, WI 53226-4216
- **Practice address phone:** (414) 259-7246
- **Mailing address:** 3106 WEDGEWOOD DR, COLGATE, WI 53017-9570

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/08/2025
- **Last updated:** 03/06/2025