Provider Demographics
NPI:1356631741
Name:MIDWEST PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MIDWEST PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNHA
Authorized Official - Phone:715-778-5545
Mailing Address - Street 1:S830 WESTLAND DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54767-8238
Mailing Address - Country:US
Mailing Address - Phone:715-778-5545
Mailing Address - Fax:715-778-5575
Practice Address - Street 1:S830 WESTLAND DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SPRING VALLEY
Practice Address - State:WI
Practice Address - Zip Code:54767-8238
Practice Address - Country:US
Practice Address - Phone:715-778-5545
Practice Address - Fax:715-778-5575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRING VALLEY HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-19
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12231-800251V00000X
WI0013449310400000X, 310400000X
WI0995314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251V00000XAgenciesVoluntary or Charitable
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility