Provider Demographics
NPI:1992027882
Name:SCOLIOSIS REHAB INC.
Entity type:Organization
Organization Name:SCOLIOSIS REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-295-9820
Mailing Address - Street 1:2918 POST RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-6417
Mailing Address - Country:US
Mailing Address - Phone:715-295-9820
Mailing Address - Fax:715-295-9821
Practice Address - Street 1:5219 E VIA BUENA VIS
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-2121
Practice Address - Country:US
Practice Address - Phone:715-295-9820
Practice Address - Fax:715-295-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8707174400000X
AZAZ696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty