Provider Demographics
NPI:1295803286
Name:PHYSICAL THERAPY CENTER OF RHINELANDER, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF RHINELANDER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEUER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-369-4062
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501
Mailing Address - Country:US
Mailing Address - Phone:715-369-4062
Mailing Address - Fax:715-365-1210
Practice Address - Street 1:1880 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501
Practice Address - Country:US
Practice Address - Phone:715-369-4062
Practice Address - Fax:715-365-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40413200Medicaid
86621Medicare ID - Type Unspecified