Genovacare-Wisconsin, LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

GENOVACARE-WISCONSIN, LLC

Doing business as

ICON Physical Therapy

Practice address

8575 W Forest Home Ave Ste 50
Greenfield, WI 53228-3469

Phone

(414) 525-9999

Fax

(414) 525-9971

NPI assigned

Feb 15, 2011

Organization subpart

No

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

Authorized official

Name

Thomas Martin Tomerlin

Title

Manager

Phone

(210) 564-0100

Specialties & licenses 1

Addresses

Other names 1

• ICON Physical Therapy Doing business as

Locations

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297728000000",
    "number": "1578860292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8575 W FOREST HOME AVE STE 50",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532283469",
            "telephone_number": "414-525-9999",
            "fax_number": "414-525-9971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8575 W FOREST HOME AVE STE 50",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532283469",
            "telephone_number": "414-525-9999",
            "fax_number": "414-525-9971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOVACARE-WISCONSIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2011-02-15",
        "status": "A",
        "authorized_official_last_name": "TOMERLIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "210-564-0100"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICON Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gateway Logistics and Transportation
• Brianne K Gebhardt, APNP
• Sarah Elizabeth Geboy
• Shannon Geenen, COTA
• Kelli Geisler
• James Joseph Gerber, LCSW
• Isaac Taylor Gerhartz
• Jessica R Gertz, PT
• Tammy Giannopoulos, LCSW
• Catherine Lee Gibbs, RD, CD

• Rehabilitation Clinic/Center in Greenfield, WI
• Providers in Greenfield, 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 Feb 15, 2011; 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.