Sports Physical Therapy & Rehab Specialist SC
NPI 1417455528ActiveOrganization· Clinic/Center· Union Grove, WI
Clinic/Center in Union Grove, Wisconsin, registered in NPPES in January 2018. The authorized official on file is Juana Granados, Credentialing Manager.
Overview
| NPI | 1417455528 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 24, 2018 |
| Last updated in NPPES | Apr 6, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center Primary | 261Q00000X | — | — |
| Physical Therapist | 225100000X | — | IL |
| Occupational Therapist | 225X00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Clinic/Center providers in Union Grove
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