Organization
ADVANTAGE PHYSICAL THERAPY & SPORTS REHAB, LLC
Active
Other names
CORA Physical Therapy - Kenosha North
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN KRZYMINSKI (EXECUTIVE VICE PRESIDENT)
(419) 221-6717
Entity
Organization
Contact information
Practice address
3620 57TH AVE STE 400, KENOSHA, WI 53144-4925
(262) 925-5250
(262) 925-5251
Mailing address
PO BOX 150, LIMA, OH 45802-0150
(419) 221-6717
(419) 222-0507
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100217837
—
WI
Enumeration date
07/02/2021
Last updated
02/27/2024
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