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Organization
SPORT CLINIC OF GREATER MILWAUKEE
Active
Organization
SPORT CLINIC OF GREATER MILWAUKEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW BECKER (C.F.O.)
(414) 453-8616
Entity
Organization
Contact information
Practice address
11904 W NORTH AVE, STE 100, WAUWATOSA, WI 53226-2062
(414) 453-8616
(414) 453-6150
Mailing address
11904 W NORTH AVE, STE 100, WAUWATOSA, WI 53226-2062
(414) 453-8616
(414) 453-6150
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40418200
—
WI
Enumeration date
10/04/2006
Last updated
08/22/2020
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