Healthcare Provider Details

I. General information

NPI: 1477205227
Provider Name (Legal Business Name): NEURO ADVANTAGE REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 GLOBE DR STE 206
MOUNT PLEASANT WI
53177-1615
US

IV. Provider business mailing address

7 CEDARWOOD CT
RACINE WI
53402-2603
US

V. Phone/Fax

Practice location:
  • Phone: 262-497-8099
  • Fax:
Mailing address:
  • Phone: 262-497-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH OLLEY
Title or Position: OWNER
Credential: OTR
Phone: 262-497-8099