Advantage Physical Therapy & Sports Rehab, LLC
Organization Active NPI Rehabilitation Clinic/Center · Pleasant Prairie, WI
NPI 1104497015 · NPPES record last updated Feb 27, 2024
Key facts
- NPI
- 1104497015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- ADVANTAGE PHYSICAL THERAPY & SPORTS REHAB, LLC
- Practice address
- 9809 39TH Ave Ste 2
Pleasant Prairie, WI 53158-3733 - Phone
- (262) 925-5080
- Fax
- (262) 925-5081
- NPI assigned
- Jul 2, 2021
- Organization subpart
- No
Authorized official
- Name
- Steve Krzyminski
- Title
- Exec. VP
- Phone
- (419) 221-6717
Other NPIs on the same Medicare enrollment 20
Corporate family (same tax ID) 17
Practitioners 16
-
Nicole J. Budzien, DPT
-
Michael Naumann, DPT
-
Lacy Nowicki, OTR/L
-
Lindsay C Sowa, MPT
-
Ted N Teberg, PT
-
Elizabeth Zierke, PT, DPT
-
Hannah Knutson, PT
-
Carly Schneeberg, DPT
-
Kyle Alan Tenboer, DPT
-
Hannah Zimmerman, DPT
-
Jeremiah Blaser, PT, DPT
-
Julian Colina, DPT, PT
-
Nicholas Kaczkowski, PT, DPT, MS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061121000412 | WI | Part B Supplier - Clinic/Group Practice | 8022016336 |
Receives reassigned benefits from 31 practitioners 20 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mount Pleasant, WI; Muskego, WI; New Berlin, WI; Pleasant Prairie, WI; Salem, WI; Shorewood, WI; Spooner, WI; Union Grove, WI… |
| O20210809001193 | WI | Part a Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services | 8022016336 |
8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Salem, WI; Kenosha, WI; Pleasant Prairie, WI; Muskego, WI; Burlington, WI; Mount Pleasant, WI |
National Provider Directory
- Tax ID family
- Advantage Physical Therapy Sports Rehab LLC
Locations
10405 Vermont Ave
Hayward, WI 54843
Phone (715) 699-1355
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Yes |
Addresses
Primary practice location
9809 39TH Ave Ste 2
Pleasant Prairie, WI 53158-3733
Mailing address
PO Box 150
Lima, OH 45802-0150
Phone (419) 221-6717
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100217225 | Medicaid | WI |
Other names
- CORA Physical Therapy - Pleasant Prairie
Other providers in Pleasant Prairie, WI
- Advanced Pain Management SC
- Affordable Dentures & Implants - Kenosha III, S.C.
- Anika Alam
- MHD Anas Alsawaf
- Thomas M Ambro
- Daisy Andaleon
All providers in Pleasant Prairie, WI · Rehabilitation Clinic/Center in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.