Provider Demographics
NPI:1205863602
Name:ORTHOPEDIC & SPINE THERAPY OF MENASHA SC
Entity type:Organization
Organization Name:ORTHOPEDIC & SPINE THERAPY OF MENASHA SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:920-257-2000
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:920-257-2000
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:1000 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1116
Practice Address - Country:US
Practice Address - Phone:920-727-9878
Practice Address - Fax:920-727-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40416400Medicaid
WICH3738OtherRAILROAD MEDICARE
WI102382900OtherUS DEPARTMENT OF LABOR
WI128871OtherHEALTH PARTNERS
WI4136286002OtherAMERICHOICE
WI41745500Medicaid
WICH3738OtherRAILROAD MEDICARE
WI41745500Medicaid
WI4136286002OtherAMERICHOICE
WICH3738OtherRAILROAD MEDICARE