Provider Demographics
NPI:1164080388
Name:ORTHOPEDIC & SPINE THERAPY OF NEW LONDON, SC
Entity type:Organization
Organization Name:ORTHOPEDIC & SPINE THERAPY OF NEW LONDON, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-257-2005
Mailing Address - Street 1:1000 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1116
Mailing Address - Country:US
Mailing Address - Phone:920-257-2005
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:315 E MAIN STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:HORTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54944
Practice Address - Country:US
Practice Address - Phone:920-257-2000
Practice Address - Fax:920-257-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty