Organization
ACTIVE CARE REHAB, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER A BALIK (PRESIDENT)
(414) 228-7900
Entity
Organization
Contact information
Practice address
250 W COVENTRY CT, SUITE 204, GLENDALE, WI 53217-3972
(414) 228-7900
(414) 228-7901
Mailing address
250 W COVENTRY CT, SUITE 204, GLENDALE, WI 53217-3972
(414) 228-7900
(414) 228-7901
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40423900
—
WI
05
—
40424000
—
WI
Enumeration date
07/09/2006
Last updated
07/23/2007
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