Provider Demographics
NPI:1013076652
Name:TRI-CITY PHYSICAL THERAPY & SPORTS MEDICINE SC
Entity type:Organization
Organization Name:TRI-CITY PHYSICAL THERAPY & SPORTS MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-735-9388
Mailing Address - Street 1:602 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1304
Mailing Address - Country:US
Mailing Address - Phone:715-735-9388
Mailing Address - Fax:715-735-9398
Practice Address - Street 1:602 WELLS ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1304
Practice Address - Country:US
Practice Address - Phone:715-735-9388
Practice Address - Fax:715-735-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1758-024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy