Healthcare Provider Details

I. General information

NPI: 1003165804
Provider Name (Legal Business Name): ADVANCED INSTITUTE OF REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S 108TH ST
HALES CORNERS WI
53130-1332
US

IV. Provider business mailing address

S75W20437 FIELD DR
MUSKEGO WI
53150-7400
US

V. Phone/Fax

Practice location:
  • Phone: 414-586-0036
  • Fax: 414-586-0046
Mailing address:
  • Phone: 262-510-6350
  • Fax: 866-594-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number368154
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JODI CZERNEJEWSKI
Title or Position: CEO
Credential: MS/CCC
Phone: 262-510-6350