Provider Demographics
NPI:1952968406
Name:ADVANCED REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:608-214-8706
Mailing Address - Street 1:3280 S OLD 11
Mailing Address - Street 2:
Mailing Address - City:ORFORDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53576-9610
Mailing Address - Country:US
Mailing Address - Phone:608-214-8706
Mailing Address - Fax:
Practice Address - Street 1:2004 E RIVERSIDE BLVD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4856
Practice Address - Country:US
Practice Address - Phone:608-214-8706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2022-11-09
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
WI1326472192Medicaid