Provider Demographics
NPI:1821292343
Name:UW-STEVENS POINT SPORTS MEDICINE
Entity Type:Organization
Organization Name:UW-STEVENS POINT SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ATHLETIC TRAINING SERVI
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WEILER
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:715-346-4772
Mailing Address - Street 1:2050 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1910
Mailing Address - Country:US
Mailing Address - Phone:715-346-4772
Mailing Address - Fax:715-295-8938
Practice Address - Street 1:2050 4TH AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1910
Practice Address - Country:US
Practice Address - Phone:715-346-4772
Practice Address - Fax:715-295-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty