Provider Demographics
NPI:1386673051
Name:FRANKLIN REHABILITATION LLC
Entity Type:Organization
Organization Name:FRANKLIN REHABILITATION LLC
Other - Org Name:INNOVATIVE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-356-5000
Mailing Address - Street 1:7253 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9041
Mailing Address - Country:US
Mailing Address - Phone:414-425-9700
Mailing Address - Fax:414-425-9700
Practice Address - Street 1:7253 S 76TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9041
Practice Address - Country:US
Practice Address - Phone:414-425-9700
Practice Address - Fax:414-425-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3054 - 24225100000X
WI9558 - 024225100000X
WI10605 - 024225100000X
225100000X
WI348 - 019225200000X
WI969 - 019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40172600Medicaid
WI000085015Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER