Provider Demographics
NPI:1063666220
Name:PHYSICAL THERAPY AND REHAB SPECIALISTS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND REHAB SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-201-1040
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:
Practice Address - Street 1:119 E OGDEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3590
Practice Address - Country:US
Practice Address - Phone:630-325-2664
Practice Address - Fax:866-245-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1063666220Medicaid
ILDP0227OtherRAILROAD MEDICARE
DR9009OtherRAILRAOD MEDICARE
WIWI2382Medicare PIN
DR9009OtherRAILRAOD MEDICARE
6399050001Medicare NSC