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Organization
SORUM PHYSIOTHERAPY
Active
Organization
SORUM PHYSIOTHERAPY
Active
Parent organization
SORUM PHYSIOTHERAPY, LLC
Other names
Sorum Physiotherapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
SORUM PHYSIOTHERAPY, LLC
Authorized official
WENDY KIRK (CREDENTIALING SPECIALIST)
(414) 745-0522
Entity
Organization
Contact information
Practice address
2242 W BLUEMOUND RD STE B, WAUKESHA, WI 53186-2916
(414) 429-3030
(414) 892-5745
Mailing address
5055 S 84TH ST, GREENDALE, WI 53129-1006
(414) 429-3030
(414) 892-5745
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11704-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11704-24
LICENSE
WI
Enumeration date
10/15/2017
Last updated
10/15/2017
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