Prestige Therapy and Wellness LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10950-24 Issued in WI

Legal business name

PRESTIGE THERAPY AND WELLNESS LLC

Practice address

1604 Legend Hill LN
Waukesha, WI 53189-8088

Phone

(262) 880-4664

Fax

(262) 447-0850

NPI assigned

Aug 10, 2011

Last updated

Dec 5, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Preston Brown, PTNPI 1811276660

Title

Owner

Phone

(262) 880-4664

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Preston Brown, PT

  • Physical Therapist
  • Waukesha, WI
  • NPI 1811276660
  Medicare reassignment Care Compare group NPD Authorized official
• Erin Ann Paul

  • Occupational Therapist
  • Waukesha, WI
  • NPI 1386281764
  Medicare reassignment Care Compare group NPD
• Matthew C Kinkade, DPT

  • Physical Therapist
  • Pewaukee, WI
  • NPI 1699108431
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1548549397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 LEGEND HILL LN",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531898088",
            "telephone_number": "262-880-4664",
            "fax_number": "262-447-0850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 LEGEND HILL LN",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531898088",
            "telephone_number": "262-880-4664",
            "fax_number": "262-447-0850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "PRESTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-880-4664",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10950-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew A. Pratt, LPC-IT
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• Stacy Presley, CSW
• Elizabeth Ann Primasing, RN, MS
• Darryl M. Prince, M.D.
• Alyssa K Printz, LPC
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• Physical Therapist in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.