Provider Demographics
NPI:1174683155
Name:MISSISSIPPI VALLEY PHYSICAL REHABILITATION S.C.
Entity Type:Organization
Organization Name:MISSISSIPPI VALLEY PHYSICAL REHABILITATION S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-787-6386
Mailing Address - Street 1:N1418 TIMBER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2172
Mailing Address - Country:US
Mailing Address - Phone:608-787-6386
Mailing Address - Fax:608-788-4543
Practice Address - Street 1:N1418 TIMBER VALLEY RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2172
Practice Address - Country:US
Practice Address - Phone:608-787-6386
Practice Address - Fax:608-788-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41808800Medicaid
WI41808800Medicaid