Healthcare Provider Details

I. General information

NPI: 1548322019
Provider Name (Legal Business Name): INTEGRITY SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 LINCOLN ST SUITE 2
RHINELANDER WI
54501-3674
US

IV. Provider business mailing address

1903 LINCOLN ST SUITE 2
RHINELANDER WI
54501-3674
US

V. Phone/Fax

Practice location:
  • Phone: 715-369-1001
  • Fax: 715-369-1003
Mailing address:
  • Phone: 715-369-1001
  • Fax: 715-369-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number62-039
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number434-039
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4433-024
License Number StateWI

VIII. Authorized Official

Name: MRS. THERESA M BARON
Title or Position: BUSINESS OWNER
Credential: P.T., A.T.C,
Phone: 715-369-1001