=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457948606
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORKSITE CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2020
-----------------------------------------------------
Last Update Date | 12/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 E MAIN ST
-----------------------------------------------------
City | REEDSBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53959-1961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-769-3333
-----------------------------------------------------
Fax | 608-768-3335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1815 JESSICA LN
-----------------------------------------------------
City | REEDSBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53959-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-963-9480
-----------------------------------------------------
Fax | 608-768-3335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | RODNEY HAHN
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 608-768-3333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------