Provider Demographics
NPI:1639349905
Name:RELIANT REHAB SERVICE & SUPPLY, LLC
Entity Type:Organization
Organization Name:RELIANT REHAB SERVICE & SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:715-552-3711
Mailing Address - Street 1:709 GILLETTE ST
Mailing Address - Street 2:#2
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-2381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:709 GILLETTE ST
Practice Address - Street 2:#2
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2381
Practice Address - Country:US
Practice Address - Phone:608-782-0690
Practice Address - Fax:608-782-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI004000310001101332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies