Provider Demographics
NPI:1437187135
Name:ORTHOPEDIC & SPINE THERAPY OF NEW LONDON, SC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE THERAPY OF NEW LONDON, 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 1:1620 N SHAWANO ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9368
Practice Address - Country:US
Practice Address - Phone:920-982-3670
Practice Address - Fax:920-982-4273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-11-05
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
WI40419300Medicaid
WI41745700Medicaid
WI128857OtherHEALTH PARTNERS
WICH3635OtherRAILROAD MEDICARE
WI2133174001OtherAMERICHOICE
WI611271700OtherUS DEPARTMENT OF LABOR
WI40419300Medicaid
WI128857OtherHEALTH PARTNERS
WI41745700Medicaid
WI000086015Medicare ID - Type Unspecified