Spine & Orthopedic Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5648-024 Issued in WI

Legal business name

SPINE & ORTHOPEDIC PHYSICAL THERAPY

Practice address

2958 Prairie Ave Ste B
Beloit, WI 53511-1825

Phone

(608) 368-9783

NPI assigned

Mar 27, 2007

Organization subpart

No

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

Authorized official

Name

Olalekan Lukman Ganiyu, P.T.

Title

Owner of Practice and P.T.

Phone

(608) 368-9783

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205954369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2958 PRAIRIE AVE STE B",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111825",
            "telephone_number": "608-368-9783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2958 PRAIRIE AVE STE B",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111825",
            "telephone_number": "608-368-9783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE & ORTHOPEDIC PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GANIYU",
        "authorized_official_first_name": "OLALEKAN",
        "authorized_official_middle_name": "LUKMAN",
        "authorized_official_title_or_position": "OWNER OF PRACTICE AND P.T.",
        "authorized_official_telephone_number": "608-368-9783",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "5648-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "540545994009",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40403900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Lee Solomon
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• Raymond K Spade, SAC
• Jennifer Lynn Speno
• Meghan Stade
• Tera Staffon
• Julia Aileen Stafford
• Laquisha M Stahl, NP
• Kristina Renee Stanis, BA, SAC-IT

• Physical Therapist in Beloit, WI
• Providers in Beloit, 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 22, 2020; 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.