SOUTHPORT REHAB ASSOCIATES, INC (NPI# 1114929064) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114929064 |
| Entity Type | Organization |
| Organization Name | SOUTHPORT REHAB ASSOCIATES, INC |
| Practice Address |
7201 Green Bay Rd Kenosha WI 53142-3522 |
| Practice Telephone | 2626943977 |
| Practice Fax Number | 2626945648 |
| Mailing Telephone | 2626943977 |
| Mailing Fax Number | 2626945648 |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2008-04-10 |
| Authorized Official Name | MR. WILLIAM H LETSOM (PRESIDENT) |
| Authorized Official Telephone | 2626943977 |
| Authorized Official Credential | P.T. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
WI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 41695100 | 05 | |
| WI | 41811000 | 05 |
| Street Address |
7201 GREEN BAY RD |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-3522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245610658 | Alwin A Diaz | Nurse Practitioner | 7201 Green Bay Rd, Kenosha, WI 53142-3532 | 2015-06-02 |
| 1245650837 | Ms. Elle Huck, Pta | Physical Therapy Assistant | 7201 Green Bay Rd, Kenosha, WI 53142-3532 | 2014-04-22 |
| 1295984151 | Pamela M Hileman | Physical Therapy Assistant | 7201 Green Bay Rd, Kenosha, WI 53142-3532 | 2008-09-16 |
| 1154492668 | Gs Miceli Dpm, Sc | Podiatrist | 7201 Green Bay Rd, Suite A, Kenosha, WI 53142-3532 | 2006-11-13 |
| 1548369283 | Shelley K Rogers | Physical Therapy Assistant | 7201 Green Bay Rd, Kenosha, WI 53142-3522 | 2006-09-21 |
| 1407959711 | Karen Lynne Tenuta | Physical Therapist | 7201 Green Bay Rd, Kenosha, WI 53142-3532 | 2006-09-06 |
| 1679585145 | Kim M Parrett | Physical Therapy Assistant | 7201 Green Bay Rd, Kenosha, WI 53142-3522 | 2006-08-13 |
| 1619943354 | Giuseppe S Miceli | Podiatrist | 7201 Green Bay Rd, Suite A, Kenosha, WI 53142-3532 | 2006-02-23 |
| 1740255611 | Actra Rehabilitation Associates Inc | Prosthetic/Orthotic Supplier | 7201 Green Bay Rd, Kenosha, WI 53142-3522 | 2006-02-22 |
| 1467441410 | Michael A. Hansen | Physical Therapist | 7201 Green Bay Rd, Kenosha, WI 53142-3522 | 2005-10-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 261QR0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912481185 | Visiting Nurse Community Care, Inc. | Clinic/Center | 600 52nd St Ste 300, Kenosha, WI 53140-3423 | 2018-09-24 |
| 1245472166 | Lori Ann Freisinger | Clinic/Center | 9244 29th Ave, Attn: Therapy Dept, Kenosha, WI 53143-6602 | 2009-03-25 |
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| 1508409293 | Boost Home Health LLC | Clinic/Center | 1198 121st Ave, New Richmond, WI 54017-7158 | 2019-10-24 |
| 1790270932 | Genesis Eldercare Rehabilitation Services LLC | Clinic/Center | 533 E Calumet St, Chilton, WI 53014-1649 | 2018-06-29 |
| 1225548316 | Thrive Learning Center, LLP | Clinic/Center | N3219 County Road H Ste F, Lake Geneva, WI 53147-7074 | 2017-10-03 |
| 1720431877 | Milwaukee Center for Independence | Clinic/Center | 6100 N Baker Rd, Glendale, WI 53209-3704 | 2016-07-13 |
| 1518334986 | Physiotherapy Associates Inc | Clinic/Center | 3910 W Lisbon Ave, Milwaukee, WI 53208-1834 | 2015-09-01 |
| 1417367509 | Specialized Therapy Services LLC | Clinic/Center | 890 Elm Grove Rd Ste 1-1, Elm Grove, WI 53122-2528 | 2014-04-29 |
| 1710300173 | Genesis Eldercare Rehabilitation Services LLC | Clinic/Center | 1800 Bluebell Ln, C/o Harmony of Stevens Point, Stevens Point, WI 54482-8983 | 2014-01-21 |
| 1386900918 | Ministry Door County | Clinic/Center | 323 S 16th Pl, Sturgeon Bay, WI 54235 | 2012-04-09 |
| 1720364045 | Kreative Connexions Therapy Services, LLC | Clinic/Center | 3111 W National Ave, Milwaukee, WI 53215-1127 | 2011-11-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.