Healthcare Provider Details

I. General information

NPI: 1073588992
Provider Name (Legal Business Name): ACTRA REHABILITATION ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 S WASHBURN ST
OSHKOSH WI
54904-7247
US

IV. Provider business mailing address

1931 S WASHBURN ST
OSHKOSH WI
54904-8292
US

V. Phone/Fax

Practice location:
  • Phone: 920-426-1231
  • Fax: 920-231-8006
Mailing address:
  • Phone: 920-426-1231
  • Fax: 920-231-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOHN DUGGAN
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 717-972-1100