Northwoods Physical Therapy Clinic & Fitness Center Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3070-024 Issued in WI

Legal business name

NORTHWOODS PHYSICAL THERAPY CLINIC & FITNESS CENTER INC

Practice address

15537 W Hwy 77 East
Hayward, WI 54843

Phone

(715) 634-2165

Fax

(715) 634-1846

NPI assigned

Mar 2, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Michael Paul McCusker, R.P.T.NPI 1386833051

Title

President/Chief Physical Therapist

Phone

(715) 634-2165

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael McCusker, R.P.T.

  • Physical Therapist
  • Hayward, WI
  • NPI 1386833051
  Medicare reassignment NPD Authorized official
• James F Harrison, M.D.

  • Family Medicine Physician
  • Cottage Grove, OR
  • NPI 1174592208
  NPD (past)

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267660800000",
    "number": "1043349566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 13018",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "54843",
            "telephone_number": "715-634-2165",
            "fax_number": "715-634-1846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15537 W HWY 77 EAST",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "54843",
            "telephone_number": "715-634-2165",
            "fax_number": "715-634-1846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWOODS PHYSICAL THERAPY CLINIC & FITNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2010-03-04",
        "status": "A",
        "authorized_official_last_name": "MCCUSKER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT/CHIEF PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "715-634-2165",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3070024",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3070-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE REGION CLAIMS",
            "identifier": "W10003647",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "650013194",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northland Counseling Services LTD
• Northland Counseling Services LTD
• Northwest Counseling & Guidance Clinic
• Northwoods Behavioral Health Services, LLC.
• Northwoods Chiropractic Inc.
• Dorothy Agnes Novak, M.D.
• NSH Valley of Hayward LLC
• Sarah L Olson, MA, LPC
• Ooboodash Cares Wellness Services LLC
• Optom-Eyes Care LLC

• All providers in Hayward, WI
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2010; 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.