Provider Demographics
NPI:1316263361
Name:BEHAVIORAL PHYISICAL THERAPY, WELLNESS & HOME CARE CENTER LLC
Entity type:Organization
Organization Name:BEHAVIORAL PHYISICAL THERAPY, WELLNESS & HOME CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-352-1826
Mailing Address - Street 1:1785 E SAHARA AVE
Mailing Address - Street 2:SUITE 490
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 W COVENTRY CT
Practice Address - Street 2:SUITE 316
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3954
Practice Address - Country:US
Practice Address - Phone:414-352-1826
Practice Address - Fax:414-352-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health