Healthcare Provider Details

I. General information

NPI: 1811920887
Provider Name (Legal Business Name): ORTHOPEDIC & SPINE THERAPY OF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 FAIRWAY DR
BRILLION WI
54110-1435
US

IV. Provider business mailing address

4000 N. PROVIDENCE AVENUE
APPLETON WI
54913-8018
US

V. Phone/Fax

Practice location:
  • Phone: 920-756-9340
  • Fax: 920-756-2711
Mailing address:
  • Phone: 920-257-2000
  • Fax: 920-257-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAUL STEVEN BARNETT
Title or Position: OWNER-PRESIDENT
Credential: PT
Phone: 920-257-2000