Healthcare Provider Details

I. General information

NPI: 1174679864
Provider Name (Legal Business Name): NORTHWOODS SPORT & HAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 LAKELAND DR SUITE A
CHIPPEWA FALLS WI
54729-5027
US

IV. Provider business mailing address

757 LAKELAND DR SUITE A
CHIPPEWA FALLS WI
54729-5027
US

V. Phone/Fax

Practice location:
  • Phone: 715-723-5060
  • Fax: 715-723-5149
Mailing address:
  • Phone: 715-723-5060
  • Fax: 715-723-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateWI

VIII. Authorized Official

Name: TJ NERENG
Title or Position: OWNER/PT
Credential:
Phone: 715-839-9266