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General NPI Number Information
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NPI Number | 1043252695
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Entity Type | Organization
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Legal Business Name | SPORT & SPINE CLINIC LP
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 10524 GEORGE AVE SUITE 2
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City | AUBURNDALE
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State | WI
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Zip | 54412-9677
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Country | US
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Telephone | 715-652-3470
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Fax | 715-652-3473
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Provider Business Mailing Address
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Address Line | 327 N 17TH AVE STE 7
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City | WAUSAU
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State | WI
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Zip | 54401-4283
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Country | US
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Telephone | 715-845-2942
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Fax | 715-842-3416
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Authorized Official
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Title or Position | VP, AUTHORIZED OFFICIAL
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Name | RICHARD BINSTEIN
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Credential |
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Telephone | 713-297-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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