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Organization
GL REHABILITATION SERVICES LTD
Active
Organization
GL REHABILITATION SERVICES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ILENE L LARSON PT MS (REHABILITATION AGENCY ADMINISTRATOR)
(608) 223-1452
Entity
Organization
Contact information
Practice address
470 GARFIELD AVE, EVANSVILLE, WI 53536-1014
(608) 882-6557
(608) 882-6559
Mailing address
2620 WAUNONA WAY, MADISON, WI 53713-1525
(608) 223-1452
(608) 223-1459
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
NULL
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
NULL
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41814300
—
WI
Enumeration date
05/19/2006
Last updated
07/15/2015
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