Healthcare Provider Details

I. General information

NPI: 1174683155
Provider Name (Legal Business Name): MISSISSIPPI VALLEY PHYSICAL REHABILITATION S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N1418 TIMBER VALLEY RD
LA CROSSE WI
54601-2172
US

IV. Provider business mailing address

N1418 TIMBER VALLEY RD
LA CROSSE WI
54601-2172
US

V. Phone/Fax

Practice location:
  • Phone: 608-787-6386
  • Fax: 608-788-4543
Mailing address:
  • Phone: 608-787-6386
  • Fax: 608-788-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHLEEN SEITZ
Title or Position: VICE PRESIDENT
Credential:
Phone: 608-787-6386