Healthcare Provider Details

I. General information

NPI: 1528004553
Provider Name (Legal Business Name): SPORT & SPINE CLINIC LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 WESTERN AVE SUITE B
MOSINEE WI
54455-1529
US

IV. Provider business mailing address

327 N 17TH AVE STE 7
WAUSAU WI
54401-4283
US

V. Phone/Fax

Practice location:
  • Phone: 715-693-7727
  • Fax: 715-693-7171
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP/AUTHORIZED OFFICIAL
Credential: JD
Phone: 713-297-7000