MEDICARE: MIDWEST PHYSICAL THERAPY

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	251V00000X	Voluntary or Charitable Agency	12231-800	WI
2	310400000X	Assisted Living Facility	0013449	WI
3	314000000X	Skilled Nursing Facility	0995	WI

General Provider Information

NPI Number	:	1356631741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	S830 WESTLAND DR
Second Line	:
City	:	SPRING VALLEY
State	:	WI
Zip	:	54767-8238
Country	:	US
Telephone Number	:	715-778-5545
Fax Number	:	715-778-5575

Provider Business Practice Location Address
First Line	:	S830 WESTLAND DR
Second Line	:	SUITE 103
City	:	SPRING VALLEY
State	:	WI
Zip	:	54767-8238
Country	:	US
Telephone Number	:	715-778-5545
Fax Number	:	715-778-5575

Authorized Official
Title or Position	:	ADMINISTRATOR/CHIEF EXECUTIVE OFFIC
Name	:	MR. KEVIN H. LARSON
Credential	:	CNHA
Telephone Number	:	715-778-5545

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	09/18/2019

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Directions to “MIDWEST PHYSICAL THERAPY ” Practice Location

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