Provider Demographics
NPI:1205880879
Name:GL REHABILITATION SERVICES LTD
Entity type:Organization
Organization Name:GL REHABILITATION SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATION AGENCY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT MS
Authorized Official - Phone:608-223-1452
Mailing Address - Street 1:2620 WAUNONA WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1525
Mailing Address - Country:US
Mailing Address - Phone:608-223-1452
Mailing Address - Fax:608-223-1459
Practice Address - Street 1:470 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536-1014
Practice Address - Country:US
Practice Address - Phone:608-882-6557
Practice Address - Fax:608-882-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41814300Medicaid
WI41814300Medicaid