Provider Demographics
NPI:1831164706
Name:ACTRA REHABILITATION ASSOCIATES INC
Entity type:Organization
Organization Name:ACTRA REHABILITATION ASSOCIATES INC
Other - Org Name:
Other - Org Type:
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 1:2727 W CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2908
Mailing Address - Country:US
Mailing Address - Phone:414-647-8828
Mailing Address - Fax:414-647-8878
Practice Address - Street 1:2727 W CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2908
Practice Address - Country:US
Practice Address - Phone:414-647-8828
Practice Address - Fax:414-647-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41790700Medicaid
WI41790700Medicaid