NPIMap

Organization Active NPI

Advantage Physical Therapy & Sports Rehab, LLC

Doing business as CORA Physical Therapy - Cudahy

  • Rehabilitation Clinic/Center
  • Cudahy, WI
National Provider Identifier
1194396002
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
Doing business as
CORA Physical Therapy - Cudahy
Practice address
3503 E Layton Ave Unit 100
Cudahy, WI 53110-1408
Phone
(414) 489-0270
Fax
(414) 489-0356
NPI assigned
Jul 2, 2021
Last updated
Feb 27, 2024By the provider in NPPES
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

3503 E Layton Ave Unit 100
Cudahy, WI 53110-1408

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
100218652MedicaidWI

Other names 1

  • CORA Physical Therapy - Cudahy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI3 enrollments

Enrollment records 3

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
O20220128000968 WI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 8022016336 6 other NPIs on this enrollment
Practice locations: Hales Corners, WI; Shorewood, WI; Milwaukee, WI; Kenosha, WI; Franklin, WI; Cudahy, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194396002. Details of each certification follow.

  • CCN 526613 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 526613

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CORA PHYSICAL THERAPY CUDAHY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Oct 7, 2022
Last certification
Oct 7, 2022
Ownership / control type
Proprietary
Facility address
3503 E Layton Ave Unit 100
Cudahy, WI 53110

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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

Locations

204 S Pine St
Burlington, WI 53105
Phone (262) 767-9579

Practitioners & affiliated clinicians

Practitioners 9

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": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1194396002",
    "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": "3503 E LAYTON AVE UNIT 100",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531101408",
            "telephone_number": "414-489-0270",
            "fax_number": "414-489-0356"
        }
    ],
    "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": "100218652",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - Cudahy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CORA Physical Therapy - Cudahy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cudahy, WI

Sources for this page

Verify at the official NPI Registry.