Provider Demographics
NPI:1649389479
Name:EXCELREHAB & SPINE CENTER, INC.
Entity Type:Organization
Organization Name:EXCELREHAB & SPINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-358-1929
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-0011
Mailing Address - Country:US
Mailing Address - Phone:715-358-1929
Mailing Address - Fax:715-356-4031
Practice Address - Street 1:8554 HWY 51 NORTH
Practice Address - Street 2:UNIT 6/7
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548
Practice Address - Country:US
Practice Address - Phone:715-358-1929
Practice Address - Fax:715-356-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41232500Medicaid
WI41232500Medicaid
WI000044035Medicare ID - Type Unspecified