Advantage Physical Therapy & Sports Rehab, LLC
Organization Active NPI Rehabilitation Clinic/Center · Mount Pleasant, WI
NPI 1821669748 · NPPES record last updated Feb 27, 2024
Key facts
- NPI
- 1821669748
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- ADVANTAGE PHYSICAL THERAPY & SPORTS REHAB, LLC
- Practice address
- 7200 Washington Ave Ste 104
Mount Pleasant, WI 53406-6516 - Phone
- (262) 583-0790
- Fax
- (262) 583-0768
- 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
Corporate family (same tax ID) 17
Member of 1
Practitioners 7
-
Amy Jo Helminski, PT MS OCS
-
Nicole M Iwanowski, OTR/L, CLT
-
Nicholas Kaczkowski, PT, DPT, MS
-
Nicole J. Budzien, DPT
-
Carly Schneeberg, DPT
-
Jeremiah Blaser, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 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 |
National Provider Directory
- Tax ID family
- Advantage Physical Therapy Sports Rehab LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Yes |
Addresses
Primary practice location
7200 Washington Ave Ste 104
Mount Pleasant, WI 53406-6516
Mailing address
PO Box 150
Lima, OH 45802-0150
Phone (419) 221-6717
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100218700 | Medicaid | WI |
Other names
- CORA Physical Therapy - Racine
Other providers in Mount Pleasant, WI
- Tanvi Adusumilli
- Advanced Dental Specialists, LLC
- Advanced Pain Management SC
- Advanced Spine and Sport
- Advanced Surgical Center LLC
- Advantage PT & Sports Rehab LLC
- Jacob John Agbuis
- Tirumala Aggarwal
- Ammar Asif Ahmed
- Syeda Maham Ahmed
All providers in Mount Pleasant, 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.