Organization
LEGACY PHYSIATRY GROUP WISCONSIN, LLC
Active
Other names
Legacy Physiatry Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIVEK SASTRY DO (PRESIDENT/CEO)
(972) 372-1663
Entity
Organization
Contact information
Practice address
200 S EXECUTIVE DR, SUITE 101, BROOKFIELD, WI 53005-4216
(972) 372-1663
Mailing address
850 CENTRAL PKWY E, SUITE 275, PLANO, TX 75074-5561
(972) 372-1663
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
06/12/2015
Last updated
06/12/2015
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