Provider Demographics
NPI:1760929178
Name:GREENFIELD PHYSICAL THERAPY & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:GREENFIELD PHYSICAL THERAPY & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-635-3979
Mailing Address - Street 1:112 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-1487
Mailing Address - Country:US
Mailing Address - Phone:715-635-3979
Mailing Address - Fax:262-925-5001
Practice Address - Street 1:112 ASH ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1487
Practice Address - Country:US
Practice Address - Phone:715-635-3979
Practice Address - Fax:715-635-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK100369018Medicare PIN