Southport Rehab Associates, Inc

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

SOUTHPORT REHAB ASSOCIATES, INC

Practice address

7201 Green Bay Rd
Kenosha, WI 53142-3522

Phone

(262) 694-3977

Fax

(262) 694-5648

NPI assigned

Aug 11, 2005

Organization subpart

No

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

Authorized official

Name

Mr. William H Letsom, P.T.

Title

President

Phone

(262) 694-3977

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 3

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

• Lisa A. Hannes, P.T.

  • Physical Therapist
  • Greenfield, WI
  • NPI 1033108212
  NPD (past)
• Mary S. Hansen, PT

  • Physical Therapist
  • Racine, WI
  • NPI 1740279769
  NPD (past)
• Clinton Charles Warren, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Kenosha, WI
  • NPI 1902162076
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1114929064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7201 GREEN BAY RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423522",
            "telephone_number": "262-694-3977",
            "fax_number": "262-694-5648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 GREEN BAY RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423522",
            "telephone_number": "262-694-3977",
            "fax_number": "262-694-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT REHAB ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "LETSOM",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-694-3977",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41695100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41811000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Hope Homes LLC
• Southport Healthcare LLC
• Southport Healthcare LLC
• Southport Healthcare LLC
• Southport Periodontics
• Southport Transportation Inc
• Jennifer Sowa, D.T.
• Lindsay C Sowa, MPT
• Briana Sowinski I, LPC
• Sozo Chiropractic

• Rehabilitation Clinic/Center in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Rehabilitation Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; 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.