Provider Demographics
NPI:1003825985
Name:ORTHOPEDIC & SPINE THERAPY OF LADYSMITH SC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE THERAPY OF LADYSMITH SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:920-257-2000
Mailing Address - Street 1:4000 N. PROVIDENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2000
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:400 W 9TH ST N
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1252
Practice Address - Country:US
Practice Address - Phone:715-532-3439
Practice Address - Fax:715-532-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI121630OtherHEALTH PARTNERS
WI4136290001OtherAMERICHOICE
WI41751800Medicaid
WIDE9938OtherRAILROAD MEDICARE
WI40425400Medicaid
WI609586900OtherUS DEPT OF LABOR
WI40425400Medicaid
WI4136290001OtherAMERICHOICE
WI000086021Medicare UPIN
WI40425400Medicaid