| NPI | 1841694650 |
|---|---|
| Doing Business As | VINTAGE VIEW THERAPY |
| Entity Type | Organization |
| Authorized Contact | ADAM WALLOW Managing Principal 262-242-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2015-12-07 |