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General NPI Number Information
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NPI Number | 1013076652
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Entity Type | Organization
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Legal Business Name | TRI-CITY PHYSICAL THERAPY & SPORTS MEDICINE SC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 602 WELLS ST
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City | MARINETTE
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State | WI
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Zip | 54143-1304
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Country | US
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Telephone | 715-735-9388
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Fax | 715-735-9398
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Provider Business Mailing Address
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Address Line | 602 WELLS ST
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City | MARINETTE
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State | WI
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Zip | 54143-1304
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Country | US
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Telephone | 715-735-9388
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Fax | 715-735-9398
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KIM BARRETTE
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Credential | PT
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Telephone | 715-735-9388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1758-024
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License Number State | WI
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