Provider Demographics
NPI:1699978254
Name:MILAN GRBIC, PT LLC
Entity type:Organization
Organization Name:MILAN GRBIC, PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRBIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:414-342-0208
Mailing Address - Street 1:950 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3352
Mailing Address - Country:US
Mailing Address - Phone:414-342-0208
Mailing Address - Fax:414-342-0508
Practice Address - Street 1:950 N 35TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3352
Practice Address - Country:US
Practice Address - Phone:414-342-0208
Practice Address - Fax:414-342-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4775024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40331400Medicaid
WI40331400Medicaid