Provider Demographics
NPI:1760648885
Name:ORTHOPAEDIC ASSOCIATES OF MANITOWOC LTD
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF MANITOWOC LTD
Other - Org Name:EXPERT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-682-6376
Mailing Address - Street 1:PO BOX 0907
Mailing Address - Street 2:920 STATE STREET
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-0907
Mailing Address - Country:US
Mailing Address - Phone:920-683-1900
Mailing Address - Fax:920-683-1907
Practice Address - Street 1:920 STATE STREET
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54221-0907
Practice Address - Country:US
Practice Address - Phone:920-683-1900
Practice Address - Fax:920-683-1907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC ASSOCAITES OF MANITOWOC LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-29
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41232800Medicaid
WI41232800Medicaid