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General NPI Number Information
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NPI Number | 1538170766
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC & SPINE THERAPY OF POPLAR, SC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 9675 E ELM RD
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City | POPLAR
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State | WI
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Zip | 54864-9102
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Country | US
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Telephone | 715-364-8565
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Fax | 715-364-8574
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Provider Business Mailing Address
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Address Line | 4000 N. PROVIDENCE AVENUE
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City | APPLETON
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State | WI
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Zip | 54913-8018
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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 AND 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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