Advantage Physical Therapy & Sports Rehab, LLC
Organization Active NPI Rehabilitation Clinic/Center · Cudahy, WI
NPI 1194396002 · NPPES record last updated Feb 27, 2024
Key facts
- NPI
- 1194396002
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- ADVANTAGE PHYSICAL THERAPY & SPORTS REHAB, LLC
- 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
- Organization subpart
- No
Authorized official
- Name
- Steve Krzyminski
- Title
- Exec. VP
- Phone
- (419) 221-6717
Other NPIs on the same Medicare enrollment 20
Other NPIs with the same Medicare PAC ID 2
Practitioners 296
-
Nicole J. Budzien, DPT
-
Elizabeth Zierke, PT, DPT
-
Arvind Ahuja, M.D.
-
MHD Anas Alsawaf, MBBS, MD
-
Dennis J. Andersen, M.D.
-
Bindu S. Bamrah, M.D.
-
Erika J Basse, PAC
-
Martin C Baur, M.D.
-
Jamie Lea Taylor Bell, PA-C
-
Megan Bellman, PAS-2
-
Jonathan Liron Ben-Zev, M.D.
-
Troy Lyman Berg, M.D.
-
John C Berschback, M.D.
-
Shashi Bhushan, MD
-
Angela C Brandes, MD
-
Ryan Brower, M.D.
-
Frederick K. Bulacan, M.D.
-
Adam Robert Burmeister, PA-C
-
James M Bury, MD
-
Jeffrey J Butler, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 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 |
| 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 |
National Provider Directory
Locations
204 S Pine St
Burlington, WI 53105
Phone (262) 767-9579
7200 Washington Ave
Ste 103
Mount Pleasant, WI 53406
Phone (262) 583-0790
S74W17045 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4678
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100218652 | Medicaid | WI |
Other names
- CORA Physical Therapy - Cudahy
Other providers in Cudahy, WI
- Access Elevator Inc
- Access Mobility Vans, Inc.
- Gretshen M Acevedo Vera
- Lauren Ann Ackerman
- Mustafa Aden
- Mary Oluwakemi Akande
- Fatima Ali
- Margarite Allar
- Allen Family Medicine SC
- Nikki Allen
All providers in Cudahy, 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.