Provider Demographics
NPI:1568171395
Name:HAND TO SHOULDER CENTER OF WISCONSIN, LTD.
Entity Type:Organization
Organization Name:HAND TO SHOULDER CENTER OF WISCONSIN, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-702-8785
Mailing Address - Street 1:2323 N CASALOMA DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8284
Mailing Address - Country:US
Mailing Address - Phone:920-730-8833
Mailing Address - Fax:
Practice Address - Street 1:E3277 APPLE TREE LN
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-7580
Practice Address - Country:US
Practice Address - Phone:920-730-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAND TO SHOULDER CENTER OF WISCONSIN, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies