Healthcare Provider Details

I. General information

NPI: 1841245701
Provider Name (Legal Business Name): SUNDANCE REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 S PRAIRIE HILL LN C/O HICKORY PARK
GREENFIELD WI
53228-2371
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 414-546-3371
  • Fax: 847-360-9311
Mailing address:
  • Phone: 610-925-4560
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IAN OPPEL
Title or Position: COO
Credential:
Phone: 980-254-7007