Provider Demographics
NPI:1992180814
Name:ACCELERATED REHABILITATION CENTER OF KENOSHA LTD
Entity Type:Organization
Organization Name:ACCELERATED REHABILITATION CENTER OF KENOSHA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UPFRONT SYSTEMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TASYA
Authorized Official - Middle Name:
Authorized Official - Last Name:EXNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-657-0222
Mailing Address - Street 1:2998 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5330
Mailing Address - Country:US
Mailing Address - Phone:262-657-0222
Mailing Address - Fax:262-657-7190
Practice Address - Street 1:34572 N US HIGHWAY 45
Practice Address - Street 2:SPACE A
Practice Address - City:THIRD LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-4037
Practice Address - Country:US
Practice Address - Phone:847-548-3695
Practice Address - Fax:847-548-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty