Healthcare Provider Details

I. General information

NPI: 1225075203
Provider Name (Legal Business Name): SACRED HEART REHABILITATION INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N LAKE DR
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

PO BOX 860496
MINNEAPOLIS MN
55486-0496
US

V. Phone/Fax

Practice location:
  • Phone: 414-585-6884
  • Fax: 414-298-6737
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MCCULLOUGH
Title or Position: CFO
Credential:
Phone: 414-465-3736