NPIMap

Organization Active NPI

Advantage Physical Therapy & Sports Rehab, LLC

  • Rehabilitation Clinic/Center
  • Salem, WI
National Provider Identifier
1104497023
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
ADVANTAGE PHYSICAL THERAPY & SPORTS REHAB, LLC
Practice address
7137 236TH Ave Ste 101
Salem, WI 53168-8975
Phone
(262) 925-5060
Fax
(262) 925-5061
NPI assigned
Jul 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Authorized official

Name
Steve Krzyminski
Title
Exec. VP
Phone
(419) 221-6717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

7137 236TH Ave Ste 101
Salem, WI 53168-8975

Mailing address

PO Box 150
Lima, OH 45802-0150
Phone (419) 221-6717

Other identifiers 1

IdentifierTypeStateIssuer
100217236MedicaidWI

Other names 1

  • CORA Physical Therapy - Paddock Lake Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Advantage Physical Therapy Sports Rehab LLC18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

7740 S Lovers Lane Rd
Ste 410
Franklin, WI 53132
Phone (414) 377-6933

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1104497023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458020150",
            "telephone_number": "419-221-6717",
            "fax_number": "419-222-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7137 236TH AVE STE 101",
            "city": "SALEM",
            "state": "WI",
            "postal_code": "531688975",
            "telephone_number": "262-925-5060",
            "fax_number": "262-925-5061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE PHYSICAL THERAPY & SPORTS REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-02",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "KRZYMINSKI",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "EXEC. VP",
        "authorized_official_telephone_number": "419-221-6717"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100217236",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - Paddock Lake",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CORA Physical Therapy - Paddock Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.