Provider Demographics
NPI:1033795174
Name:CONCIERGE REHAB GROUP LLC
Entity type:Organization
Organization Name:CONCIERGE REHAB GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-216-3518
Mailing Address - Street 1:302 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2220
Mailing Address - Country:US
Mailing Address - Phone:224-216-3518
Mailing Address - Fax:
Practice Address - Street 1:525 JUNCTION RD STE 6500
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2153
Practice Address - Country:US
Practice Address - Phone:224-216-3518
Practice Address - Fax:312-500-4687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFF MATHIS ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty