Organization
MIDWEST REHABILITATION ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY WRIGHT (EXECUTIVE DIRECTOR)
(414) 476-8183
Entity
Organization
Contact information
Practice address
2525 N MAYFAIR RD, SUITE 200, WAUWATOSA, WI 53226-1403
(414) 476-8183
(414) 476-8465
Mailing address
2525 N MAYFAIR RD, SUITE 200, WAUWATOSA, WI 53226-1403
(414) 476-8183
(414) 476-8465
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TH0100X
Health Service Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137184000
US DEPT OF LABOR ID
WI
05
—
21280000
—
WI
Enumeration date
08/31/2006
Last updated
12/17/2012
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