NPIMap

Organization Active NPI

Victory Physical Therapy and Wellness Specialists

  • Physical Therapist
  • Marinette, WI
National Provider Identifier
1699888636
Registry record updated Mar 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9832024 Issued in WI
Legal business name
VICTORY PHYSICAL THERAPY AND WELLNESS SPECIALISTS
Practice address
3908 Hall Ave
Suite a
Marinette, WI 54143-1018
Phone
(715) 732-4127
Fax
(715) 732-4137
NPI assigned
Aug 16, 2006
Last updated
Mar 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2008

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

Authorized official

Name
Larry Briand, PT, ATCNPI 1275573198
Title
Co-Owner
Phone
(877) 552-2996

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 9832024 WI Primary

Addresses

Primary practice location

3908 Hall Ave
Suite a
Marinette, WI 54143-1018

Mailing address

PO Box 3497
Sturtevant, WI 53177-0300
Phone (877) 552-2996

Other identifiers 1

IdentifierTypeStateIssuer
40426400MedicaidWI

National Provider Directory

National Provider Directory

Locations

3908 Hall Ave
#A
Marinette, WI 54143
Phone (715) 732-4127

3908 Hall Ave
Ste A
Marinette, WI 54143
Phone (715) 732-4127

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205107200000",
    "number": "1699888636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3497",
            "city": "STURTEVANT",
            "state": "WI",
            "postal_code": "531770300",
            "telephone_number": "877-552-2996",
            "fax_number": "886-245-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3908 HALL AVE",
            "address_2": "SUITE A",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541431018",
            "telephone_number": "715-732-4127",
            "fax_number": "715-732-4137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY PHYSICAL THERAPY AND WELLNESS SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-03-10",
        "status": "A",
        "authorized_official_last_name": "BRIAND",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "877-552-2996",
        "authorized_official_credential": "PT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "9832024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40426400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marinette, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2008; 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.