Healthcare Provider Details

I. General information

NPI: 1962690883
Provider Name (Legal Business Name): STELLAR REHABILITATION, LLC HARBOR HOUSE BURKE ROAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 BURKE RD
MADISON WI
53718-6301
US

IV. Provider business mailing address

1049 N EDGE TRL
VERONA WI
53593-1942
US

V. Phone/Fax

Practice location:
  • Phone: 608-845-2100
  • Fax: 608-845-2101
Mailing address:
  • Phone: 608-845-2100
  • Fax: 608-845-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9730-024
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2335-026
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2089-154
License Number StateWI

VIII. Authorized Official

Name: MS. SUSAN ARMSTRONG
Title or Position: MASTER PHYSICAL THERAPIST
Credential: MPT
Phone: 608-845-2100