1225140411 NPI number — RIVER VALLEY PHYSICAL THERAPY, INC

Table of content: (NPI 1225140411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225140411 NPI number — RIVER VALLEY PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER VALLEY PHYSICAL THERAPY, 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:
1225140411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 S 2ND ST STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54022-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-426-7878
Provider Business Mailing Address Fax Number:
715-426-7852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 S 2ND ST STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVER FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54022-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-426-7878
Provider Business Practice Location Address Fax Number:
715-426-7852
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROTSAERT
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
715-426-7878

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1225140411 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87418 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1032050 . This is a "PREFERRED ONE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 242T8RI . This is a "BCBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 40421400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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