Organization
GENOVACARE-WISCONSIN, LLC
Active
Other names
ICON Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MARTIN TOMERLIN (MANAGER)
(210) 564-0100
Entity
Organization
Contact information
Practice address
8575 W FOREST HOME AVE STE 50, GREENFIELD, WI 53228-3469
(414) 525-9999
(414) 525-9971
Mailing address
8575 W FOREST HOME AVE STE 50, GREENFIELD, WI 53228-3469
(414) 525-9999
(414) 525-9971
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/15/2011
Last updated
02/15/2011
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