MEDICARE: NORTHWOODS SPORT & HAND, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1437828068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOODS SPORT & HAND, INC

Provider Business Mailing Address
First Line	:	1200 OAKLEAF WAY STE B
Second Line	:
City	:	ALTOONA
State	:	WI
Zip	:	54720-2245
Country	:	US
Telephone Number	:	715-839-9266
Fax Number	:	715-839-8761

Provider Business Practice Location Address
First Line	:	1855 125TH ST
Second Line	:
City	:	LAKE HALLIE
State	:	WI
Zip	:	54729-6306
Country	:	US
Telephone Number	:	715-839-9266
Fax Number	:	715-839-8761

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	TJ NERENG
Credential	:	PT, DPT, OCS
Telephone Number	:	715-839-9266

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	02/19/2024

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