Organization
ENDEAVOR THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN IRENE BLOCK (ADMINISTRATOR)
(262) 241-8892
Entity
Organization
Contact information
Practice address
11649 N PORT WASHINGTON RD, STE 109, MEQUON, WI 53092-3460
(262) 241-8892
(262) 241-8894
Mailing address
11649 N PORT WASHINGTON RD, STE 109, MEQUON, WI 53092-3460
(262) 241-8892
(262) 241-8894
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40076000
—
WI
Enumeration date
08/11/2005
Last updated
06/11/2010
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