Provider Demographics
NPI:1417017369
Name:NORTH EASTERN WISCONSIN REHABILITATION CORPORATION
Entity Type:Organization
Organization Name:NORTH EASTERN WISCONSIN REHABILITATION CORPORATION
Other - Org Name:N.E.W. REHAB COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR
Authorized Official - Phone:920-982-5440
Mailing Address - Street 1:307 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-1410
Mailing Address - Country:US
Mailing Address - Phone:920-982-5440
Mailing Address - Fax:
Practice Address - Street 1:307 SMITH ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-1410
Practice Address - Country:US
Practice Address - Phone:920-982-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10012-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41220300Medicaid
WI86524Medicare ID - Type Unspecified