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General NPI Number Information
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NPI Number | 1205863602
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC & SPINE THERAPY OF MENASHA SC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 1000 MIDWAY RD
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City | MENASHA
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State | WI
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Zip | 54952-1116
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Country | US
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Telephone | 920-727-9878
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Fax | 920-727-9903
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Provider Business Mailing Address
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Address Line | 1000 MIDWAY RD
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City | MENASHA
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State | WI
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Zip | 54952-1116
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Country | US
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Telephone | 920-257-2000
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Fax | 920-257-2004
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Authorized Official
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Title or Position | OWNER-PRESIDENT
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Name | PAUL STEVEN BARNETT
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Credential | PT
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Telephone | 920-257-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | WI
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