Advanced Spine and Sport

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ADVANCED SPINE AND SPORT

Doing business as

Advanced Spine and Sport Rehabilitation

Practice address

6222 Washington Ave
Mount Pleasant, WI 53406-3948

Phone

(262) 884-6418

Fax

(262) 884-6489

NPI assigned

Dec 5, 2006

Last updated

Jan 13, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas D Van de Water, MPTNPI 1831257369

Title

Managing Partner

Phone

(262) 884-6418

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Advanced Spine and Sport Rehabilitation Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas D Van de Water, MPT

  • Physical Therapist
  • Mount Pleasant, WI
  • NPI 1831257369
  Medicare reassignment Care Compare group NPD Authorized official
• Alexa N Ahrens, DPT

  • Physical Therapist
  • Mount Pleasant, WI
  • NPI 1619867454
  Medicare reassignment Care Compare group NPD
• Joellyn R Pfeilstifter

  • Physical Therapist
  • Mount Pleasant, WI
  • NPI 1487139259
  Medicare reassignment Care Compare group NPD
• David N Van de Water, DPT

  • Physical Therapist
  • Mount Pleasant, WI
  • NPI 1811222938
  Medicare reassignment Care Compare group NPD
• Edward V Van Dewater, MPT CSCS

  • Physical Therapist
  • Mount Pleasant, WI
  • NPI 1083772529
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705104000000",
    "number": "1033277553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6222 WASHINGTON AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534063948",
            "telephone_number": "262-884-6418",
            "fax_number": "262-884-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6222 WASHINGTON AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534063948",
            "telephone_number": "262-884-6418",
            "fax_number": "262-884-6489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SPINE AND SPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2024-01-13",
        "certification_date": "2024-01-13",
        "status": "A",
        "authorized_official_last_name": "VAN DE WATER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "262-884-6418",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40427900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Spine and Sport Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stacey L Adams
• Angelica Adamski, LPC
• Tanvi Adusumilli, M.D.
• Advanced Dental Specialists, LLC (Advanced Dental Specialists Racine)
• Advanced Pain Management SC
• Advanced Surgical Center LLC
• Advantage Physical Therapy & Sports Rehab, LLC (CORA Physical Therapy - Racine)
• Advantage PT & Sports Rehab LLC (CORA Physical Therapy - East Racine)
• Jacob John Agbuis, PTA
• Tirumala Aggarwal, DMD

• Physical Therapist in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.