Provider Demographics
NPI:1427061027
Name:INVIVO WELLNESS RESTORATION, LLC
Entity type:Organization
Organization Name:INVIVO WELLNESS RESTORATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HESSIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-265-5606
Mailing Address - Street 1:2060 N HUMBOLDT BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3504
Mailing Address - Country:US
Mailing Address - Phone:414-265-5606
Mailing Address - Fax:414-265-5649
Practice Address - Street 1:2060 N HUMBOLDT BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3504
Practice Address - Country:US
Practice Address - Phone:414-265-5606
Practice Address - Fax:414-265-5649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4778-024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty