Healthcare Provider Details

I. General information

NPI: 1336360668
Provider Name (Legal Business Name): MIDWEST REHABILITATION NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17280 W NORTH AVE SUITE 104
BROOKFIELD WI
53045-4366
US

IV. Provider business mailing address

PO BOX 451
BROOKFIELD WI
53008-0451
US

V. Phone/Fax

Practice location:
  • Phone: 262-780-0707
  • Fax: 262-780-0717
Mailing address:
  • Phone: 262-938-3122
  • Fax: 262-938-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM H BORN
Title or Position: DIRECTOR
Credential: PT
Phone: 262-938-3122