Individual
PREH REH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4036 S 5TH PL, MILWAUKEE, WI 53207-4336
(336) 341-0203
Mailing address
4036 S 5TH PL, MILWAUKEE, WI 53207-4336
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
01/09/2026
Last updated
01/09/2026
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