Healthcare Provider Details

I. General information

NPI: 1760495964
Provider Name (Legal Business Name): JANESVILLE PHYSICAL THERAPY AND REHAB SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 MILTON AVE SUITE 201
JANESVILLE WI
53546-9802
US

IV. Provider business mailing address

PO BOX 3497
STURTEVANT WI
53177-0300
US

V. Phone/Fax

Practice location:
  • Phone: 608-757-1840
  • Fax: 608-757-1881
Mailing address:
  • Phone: 877-552-2996
  • Fax: 866-245-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5817024
License Number StateWI

VIII. Authorized Official

Name: LARRY BRIAND
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 877-552-2996