Healthcare Provider Details

I. General information

NPI: 1528172988
Provider Name (Legal Business Name): ORTHOPEDIC & SPINE THERAPY OF CLINTONVILLE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E GREEN TREE RD
CLINTONVILLE WI
54929-1182
US

IV. Provider business mailing address

1000 MIDWAY RD
MENASHA WI
54952-1014
US

V. Phone/Fax

Practice location:
  • Phone: 715-823-3336
  • Fax: 715-823-3936
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