1376648220 NPI number — INJURY REHABILITATION CLINIC II, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376648220 NPI number — INJURY REHABILITATION CLINIC II, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INJURY REHABILITATION CLINIC II, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376648220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3415 N 127TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53005-3117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-781-8144
Provider Business Mailing Address Fax Number:
262-781-8552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3415 N 127TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53005-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-781-8144
Provider Business Practice Location Address Fax Number:
262-781-8552
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATTON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
PRESIDENT, OTR
Authorized Official Telephone Number:
262-781-8144

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  892-026 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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