NPIMap

Organization Active NPI

Advantage PT & Sports Rehab LLC

  • Rehabilitation Clinic/Center
  • Milwaukee, WI
National Provider Identifier
1922769983
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 PT & SPORTS REHAB LLC
Practice address
2578 N Martin Luther King Dr
Milwaukee, WI 53212-2710
Phone
(414) 529-7375
NPI assigned
Jan 3, 2022
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Steve Krzyminski
Title
Exec VP
Phone
(419) 221-6717

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

Corporate family (same tax ID) 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Practitioners 8

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Medicare enrollment records 2

Medicare enrollment files
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…
O20220128000968 WI Part a Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 8022016336 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hales Corners, WI; Shorewood, WI; Milwaukee, WI; Kenosha, WI; Franklin, WI; Cudahy, WI

National Provider Directory

National Provider Directory
Tax ID family
Advantage Physical Therapy Sports Rehab LLC (18 organizations share this tax ID)

Locations

7137 236th Ave
Ste 101
Salem, WI 53168
Phone (262) 925-5060

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

2578 N Martin Luther King Dr
Milwaukee, WI 53212-2710

Mailing address

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

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
100192496MedicaidWI

Other names 1

NPPES NPI Registry
  • CORA Physical Therapy - MLK Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 27, 2024.

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1922769983",
    "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": "2578 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122710",
            "telephone_number": "414-529-7375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE PT & SPORTS REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-03",
        "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": "100192496",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - MLK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.