Organization
SOUTHPORT REHAB ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM H LETSOM P.T. (PRESIDENT)
(262) 694-3977
Entity
Organization
Contact information
Practice address
7201 GREEN BAY RD, KENOSHA, WI 53142-3522
(262) 694-3977
(262) 694-5648
Mailing address
7201 GREEN BAY RD, KENOSHA, WI 53142-3522
(262) 694-3977
(262) 694-5648
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41695100
—
WI
05
—
41811000
—
WI
Enumeration date
08/11/2005
Last updated
04/10/2008
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