Oconto Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1934 Issued in WI

Legal business name

OCONTO PHYSICAL THERAPY, LLC

Practice address

300 N Broadway
Suite 3C
Green Bay, WI 54303-2702

Phone

(920) 437-7246

Fax

(920) 437-1511

NPI assigned

Oct 11, 2005

Organization subpart

No

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

Authorized official

Name

Cynthia L Willette

Title

Billing Manager

Phone

(920) 437-7246

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Haight Pain Doing business as

Locations

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409097600000",
    "number": "1124016407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N BROADWAY",
            "address_2": "SUITE 3C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032702",
            "telephone_number": "920-437-7246",
            "fax_number": "920-437-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N BROADWAY",
            "address_2": "SUITE 3C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032702",
            "telephone_number": "920-437-7246",
            "fax_number": "920-437-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCONTO PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2014-08-27",
        "status": "A",
        "authorized_official_last_name": "WILLETTE",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "920-437-7246"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "1934",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "2368",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40422000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "DA7771",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haight Pain",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ohana Home Care Agency, LLC

• Physical Therapist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.