Provider Demographics
NPI:1760496749
Name:CHIPPEWA VALLEY PHYSICAL THERAPY SC
Entity Type:Organization
Organization Name:CHIPPEWA VALLEY PHYSICAL THERAPY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-726-1010
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:13707 7TH ST
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758
Mailing Address - Country:US
Mailing Address - Phone:715-597-1855
Mailing Address - Fax:715-597-1856
Practice Address - Street 1:13707 7TH ST
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758
Practice Address - Country:US
Practice Address - Phone:715-597-1855
Practice Address - Fax:715-597-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40425100Medicaid
WI00086667Medicare ID - Type Unspecified