Organization
INNOVATIONS REHABILITATION, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT A WIEDL PT (OWNER,PRESIDENT)
(608) 269-0555
Entity
Organization
Contact information
Practice address
501 W WISCONSIN ST, SPARTA, WI 54656-2332
(608) 269-0555
(608) 269-6570
Mailing address
501 W WISCONSIN ST, SPARTA, WI 54656-2332
(608) 269-0555
(608) 269-6570
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3162-024
WI
225100000X
Physical Therapist
4051 - 024
WI
225100000X
Physical Therapist
4419 - 024
WI
225100000X
Physical Therapist
9813 - 024
WI
225200000X
Physical Therapy Assistant
44 - 019
WI
225200000X
Physical Therapy Assistant
798 - 019
WI
225200000X
Physical Therapy Assistant
817 - 019
WI
225200000X
Physical Therapy Assistant
92 - 019
WI
225X00000X
Occupational Therapist
3666 - 026
WI
225X00000X
Occupational Therapist
Primary
4061 - 026
WI
225X00000X
Occupational Therapist
4281 - 026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41220800
—
WI
Enumeration date
01/03/2007
Last updated
09/11/2025
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