Organization
IN- HOME REHAB SOUTHEASTERN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC WILLIAM JOHNSON (OWNER)
(262) 331-4397
Entity
Organization
Contact information
Practice address
102 NORTH STATE STREET, ROCHESTER, WI 53167
(262) 331-4397
Mailing address
PO BOX 367, ROCHESTER, WI 53167-0367
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5627
WI
225X00000X
Occupational Therapist
4088026
WI
Other
Enumeration date
07/25/2006
Last updated
06/17/2008
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