Provider Demographics
NPI:1659346526
Name:ACTRA REHABILITATION ASSOCIATES INC
Entity Type:Organization
Organization Name:ACTRA REHABILITATION ASSOCIATES INC
Other - Org Name:NOVACARE PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1100
Mailing Address - Street 1:6514 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1124
Mailing Address - Country:US
Mailing Address - Phone:608-833-9660
Mailing Address - Fax:608-833-4733
Practice Address - Street 1:6514 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1124
Practice Address - Country:US
Practice Address - Phone:608-833-9660
Practice Address - Fax:608-833-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41790400Medicaid
WI0237460006Medicare NSC