Healthcare Provider Details

I. General information

NPI: 1013207422
Provider Name (Legal Business Name): REHAB MEDICAL SUPPLIES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 W LARAMIE LN
BAYSIDE WI
53217-1227
US

IV. Provider business mailing address

727 W LARAMIE LN
BAYSIDE WI
53217-1227
US

V. Phone/Fax

Practice location:
  • Phone: 414-444-4822
  • Fax:
Mailing address:
  • Phone: 414-444-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH JORDAN
Title or Position: ADMINISTRATOR
Credential: P.T
Phone: 414-444-4822