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General NPI Number Information
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NPI Number | 1619079506
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Entity Type | Organization
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Legal Business Name | PETERSEN REHABILITATION CENTER, INC.
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 BOYCE DR
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City | RHINELANDER
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State | WI
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Zip | 54501-3835
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Country | US
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Telephone | 715-365-6866
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Fax |
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Provider Business Mailing Address
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Address Line | 900 BOYCE DR
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City | RHINELANDER
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State | WI
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Zip | 54501-3835
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Country | US
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Telephone | 715-365-6866
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN SYKES
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Credential | P.T.
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Telephone | 715-365-6866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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