# ACTIVE CARE REHAB, S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023041381
- **Authorized official:** PETER A BALIK (PRESIDENT)
- **Authorized official phone:** (414) 228-7900

## Contact information

- **Practice address:** 250 W COVENTRY CT, SUITE 204, GLENDALE, WI 53217-3972
- **Practice address phone:** (414) 228-7900
- **Practice address fax:** (414) 228-7901
- **Mailing address:** 250 W COVENTRY CT, SUITE 204, GLENDALE, WI 53217-3972
- **Mailing address phone:** (414) 228-7900
- **Mailing address fax:** (414) 228-7901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 07/09/2006
- **Last updated:** 07/23/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 40423900 | — | WI |
| 05 | — | 40424000 | — | WI |