MEDICARE: MONONA REHABILITATION SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2804024	WI

General Provider Information

NPI Number	:	1073506622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONONA REHABILITATION SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 6157
Second Line	:	MONONA REHABILITATION SERVICES
City	:	MADISON
State	:	WI
Zip	:	53716-0157
Country	:	US
Telephone Number	:	608-222-2325
Fax Number	:	608-222-3823

Provider Business Practice Location Address
First Line	:	4100 MONONA DR
Second Line	:	MONONA REHABILITATION SERVICES
City	:	MADISON
State	:	WI
Zip	:	53716-1674
Country	:	US
Telephone Number	:	608-222-2325
Fax Number	:	608-222-3823

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY RM KUNZ
Credential	:
Telephone Number	:	608-222-2325

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	08/22/2020

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