Provider Demographics
NPI:1073775730
Name:SPORT & SPINE CLINIC OF FORT ATKINSON LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:SPORT & SPINE CLINIC OF FORT ATKINSON LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:944 WATER ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1535
Mailing Address - Country:US
Mailing Address - Phone:608-643-3495
Mailing Address - Fax:608-643-6719
Practice Address - Street 1:944 WATER ST
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1535
Practice Address - Country:US
Practice Address - Phone:608-643-3495
Practice Address - Fax:608-643-6719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPORT & SPINE CLINIC OF FORT ATKINSON LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-25
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI526592Medicare Oscar/Certification