Provider Demographics
NPI:1487821252
Name:RX REHABILITATION SERVICES
Entity type:Organization
Organization Name:RX REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEIVES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:608-513-1518
Mailing Address - Street 1:4601 W BLUE MOUNDS RD
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9720
Mailing Address - Country:US
Mailing Address - Phone:608-513-1518
Mailing Address - Fax:
Practice Address - Street 1:3151 COUNTY ROAD CH
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-9108
Practice Address - Country:US
Practice Address - Phone:608-935-3321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38290242251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41219400Medicaid