Healthcare Provider Details

I. General information

NPI: 1700703642
Provider Name (Legal Business Name): KINBRIDGE REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E 10TH ST N
LADYSMITH WI
54848-2523
US

IV. Provider business mailing address

2809 E HAMILTON AVE UNIT 2136
EAU CLAIRE WI
54701-6863
US

V. Phone/Fax

Practice location:
  • Phone: 903-508-9696
  • Fax:
Mailing address:
  • Phone: 903-508-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMANTHA A MINTEN
Title or Position: MANAGING MEMBER
Credential: OTR/L
Phone: 903-508-9696