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
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