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General NPI Number Information
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NPI Number | 1609966407
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Entity Type | Organization
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Legal Business Name | NORTHWOODS SPORT & HAND, INC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 1200 OAKLEAF WAY SUITE B
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City | ALTOONA
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State | WI
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Zip | 54720-2309
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Country | US
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Telephone | 715-839-9266
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 OAKLEAF WAY SUITE B
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City | ALTOONA
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State | WI
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Zip | 54720-2309
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Country | US
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Telephone | 715-839-9266
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Fax |
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Authorized Official
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Title or Position | PT/OWNER
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Name | TJ NERENG
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Credential | PT, DPT, OCS
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Telephone | 715-839-9266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | WI
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Legacy Identifiers
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Identifier #1
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Identifier Code | 40428500
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Identifier Type | MEDICAID
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Identifier State | WI
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Identifier Issuer |
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Identifier #2
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Identifier Code | 41638600
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Identifier Type | MEDICAID
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Identifier State | WI
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 40428500
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Identifier Type | MEDICAID
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Identifier State | WI
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Identifier Issuer |
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Identifier #2
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Identifier Code | 41638600
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Identifier Type | MEDICAID
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Identifier State | WI
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Identifier Issuer |
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