Provider Demographics
NPI:1477750255
Name:REHABILITATION INSTITUTE OF WISCONSIN, INC.
Entity Type:Organization
Organization Name:REHABILITATION INSTITUTE OF WISCONSIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STELLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-798-9650
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:275 REGENCY COURT, SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-0611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 REGENCY CT
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6168
Practice Address - Country:US
Practice Address - Phone:262-798-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52-6554Medicare ID - Type UnspecifiedMEDICARE OUTPATIENT FACIL