Provider Demographics
NPI:1174679864
Name:NORTHWOODS SPORT & HAND, INC.
Entity Type:Organization
Organization Name:NORTHWOODS SPORT & HAND, INC.
Other - Org Name:NORTHWOODS THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:TJ
Authorized Official - Middle Name:
Authorized Official - Last Name:NERENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-839-9266
Mailing Address - Street 1:757 LAKELAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5027
Mailing Address - Country:US
Mailing Address - Phone:715-723-5060
Mailing Address - Fax:715-723-5149
Practice Address - Street 1:757 LAKELAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5027
Practice Address - Country:US
Practice Address - Phone:715-723-5060
Practice Address - Fax:715-723-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QP2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6479370002OtherPTAN
WI40428500Medicaid
WI0148340001Medicare NSC
WI6479370002OtherPTAN