# IN- HOME REHAB SOUTHEASTERN

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

## Provider details

- **NPI number:** 1215950696
- **Authorized official:** ERIC WILLIAM JOHNSON (OWNER)
- **Authorized official phone:** (262) 331-4397

## Contact information

- **Practice address:** 102 NORTH STATE STREET, ROCHESTER, WI 53167
- **Practice address phone:** (262) 331-4397
- **Mailing address:** PO BOX 367, ROCHESTER, WI 53167-0367

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 5627 | WI | Yes |
| 225X00000X | Occupational Therapist | 4088026 | WI | — |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 06/17/2008