Provider Demographics
NPI:1255544862
Name:WISCONSIN ORTHOPEDIC REHABILITATION CONSULTANTS, INC.
Entity type:Organization
Organization Name:WISCONSIN ORTHOPEDIC REHABILITATION CONSULTANTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKWIERAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:262-376-9130
Mailing Address - Street 1:136 N MAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1606
Mailing Address - Country:US
Mailing Address - Phone:262-376-9130
Mailing Address - Fax:262-377-2706
Practice Address - Street 1:136 N MAIN ST STE 308
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1606
Practice Address - Country:US
Practice Address - Phone:262-478-0920
Practice Address - Fax:262-478-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40169700Medicaid
WI40169700Medicaid