Organization
LJN THERAPY, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY JOHN NOSSE PT (PRESIDENT)
(414) 453-0135
Entity
Organization
Contact information
Practice address
1404 W WISCONSIN AVE, MILWAUKEE, WI 53233-2238
(414) 288-1757
Mailing address
2345 N 114TH ST, WAUWATOSA, WI 53226-1225
(414) 453-0135
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1246
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326110859
INDIVIDUAL NPI
—
05
—
40429500
—
WI
Enumeration date
06/20/2007
Last updated
07/13/2007
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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