Sport & Spine Clinic LP

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SPORT & SPINE CLINIC LP

Practice address

503 S Cherry Ave
Suite 2
Marshfield, WI 54449-4276

Phone

(715) 652-3470

NPI assigned

Oct 21, 2015

Organization subpart

No

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

Authorized official

Name

Richard Binstein

Title

VP, Authorized Official

Phone

(713) 297-7000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 526593

Legal name

SPORT & SPINE CLINIC OF MARSHFIELD

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Aug 23, 2002

Last certification

Apr 3, 2023

Ownership / control type

Proprietary

Most recent change of ownership

Jun 1, 2014

Facility address

503 S Cherry Ave Suite 2
Marshfield, WI 54449

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Sport & Spine Clinic LP

  • Physical Therapist
  • Auburndale, WI
  • NPI 1043252695

  O20140423000103

  Same enrollment

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642377600000",
    "number": "1164894812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 N 17TH AVE STE 7",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 S CHERRY AVE",
            "address_2": "SUITE 2",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544494276",
            "telephone_number": "715-652-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT & SPINE CLINIC LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-21",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A",
        "authorized_official_last_name": "BINSTEIN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "VP, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "713-297-7000"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Suzanne Spies Ingersoll, CRNA
• Diana Midori Spieth
• Michael E Spieth, MD
• Toshia Jean Spindler, PA-C
• Elsa Spitzmueller, OT
• Pooja Srivastava, M.D.
• St Joseph'S Hospital of Marshfield, Inc
• St Joseph'S Hospital of Marshfield, Inc
• Peter Stamas, MD
• Andrew James Stangl, MD

• Physical Therapist in Marshfield, WI
• Providers in Marshfield, 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 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.