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General NPI Number Information
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NPI Number | 1649647173
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC & SPINE THERAPY OF GREEN BAY SC
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 301 N BROADWAY STE 206
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City | DE PERE
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State | WI
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Zip | 54115-2557
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Country | US
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Telephone | 920-432-9040
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 N PROVIDENCE AVE
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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 |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AMY BARNETT
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Credential |
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Telephone | 920-257-2005
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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 | 13159-24
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License Number State | WI
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