Provider Demographics
NPI:1881654622
Name:ACTRA REHABILITATION ASSOCIATES INC
Entity Type:Organization
Organization Name:ACTRA REHABILITATION ASSOCIATES INC
Other - Org Name:ACTRA REHABILITATION ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:829 S GREEN BAY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4058
Mailing Address - Country:US
Mailing Address - Phone:262-635-0191
Mailing Address - Fax:262-635-0205
Practice Address - Street 1:829 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4058
Practice Address - Country:US
Practice Address - Phone:262-635-0191
Practice Address - Fax:262-635-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41789600Medicaid
WI41789600Medicaid