NPIMap

Organization Active NPI

Active Care Rehab, S.C.

  • Physical Therapist
  • Glendale, WI
National Provider Identifier
1023041381
Registry record updated Jul 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ACTIVE CARE REHAB, S.C.
Practice address
250 W Coventry CT
Suite 204
Glendale, WI 53217-3972
Phone
(414) 228-7900
Fax
(414) 228-7901
NPI assigned
Jul 9, 2006
Last updated
Jul 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peter A BalikNPI 1932132198
Title
President
Phone
(414) 228-7900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

250 W Coventry CT
Suite 204
Glendale, WI 53217-3972

Mailing address

250 W Coventry CT
Suite 204
Glendale, WI 53217-3972
Phone (414) 228-7900

Other identifiers 2

IdentifierTypeStateIssuer
40423900MedicaidWI
40424000MedicaidWI

National Provider Directory

National Provider Directory

Locations

250 W Coventry Ct
Ste 204
Glendale, WI 53217
Phone (414) 228-7900

6300 N Port Washington Rd
Glendale, WI 53217
Phone (414) 332-9000

1220 W Ranchito Ln
Mequon, WI 53092
Phone (262) 240-9000

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185148800000",
    "number": "1023041381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W COVENTRY CT",
            "address_2": "SUITE 204",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532173972",
            "telephone_number": "414-228-7900",
            "fax_number": "414-228-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W COVENTRY CT",
            "address_2": "SUITE 204",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532173972",
            "telephone_number": "414-228-7900",
            "fax_number": "414-228-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE CARE REHAB, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2007-07-23",
        "status": "A",
        "authorized_official_last_name": "BALIK",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-228-7900"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40423900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40424000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.