Spine and Sport Physical Therapy of Waupaca LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SPINE AND SPORT PHYSICAL THERAPY OF WAUPACA LLC

Practice address

1439 Churchill St Ste 102
Waupaca, WI 54981-2089

Phone

(920) 538-3670

Fax

(715) 256-9404

NPI assigned

Jan 7, 2008

Last updated

Mar 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Ray Koch, P.T.NPI 1225058878

Title

Member

Phone

(920) 538-3670

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 5

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.

• Michael R. Koch, PT

  • Physical Therapist
  • Waupaca, WI
  • NPI 1225058878
  Medicare reassignment Care Compare group NPD Authorized official
• Kelsey Mae Abendroth, PT

  • Physical Therapist
  • New London, WI
  • NPI 1548783228
  Medicare reassignment Care Compare group NPD
• Elizabeth A Gross, DPT

  • Physical Therapist
  • Waupaca, WI
  • NPI 1679820716
  Medicare reassignment Care Compare group NPD
• Morgan R Dopp, DPT

  • Physical Therapist
  • Appleton, WI
  • NPI 1316508807
  Medicare reassignment NPD
• William Edward Weber, PT

  • Physical Therapist
  • Rhinelander, WI
  • NPI 1497834790
  NPD (past)

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205625600000",
    "number": "1770768046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1439 CHURCHILL ST STE 102",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549812089",
            "telephone_number": "920-538-3670",
            "fax_number": "715-256-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1439 CHURCHILL ST STE 102",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549812089",
            "telephone_number": "920-538-3670",
            "fax_number": "715-256-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE AND SPORT PHYSICAL THERAPY OF WAUPACA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-07",
        "last_updated": "2008-03-16",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "920-538-3670",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul William Sletten, M.D.
• Dean Jerome Sondrol
• Michelle A Soto, MD
• James P Spencer, MD
• Bonnie J Sperberg, P.T.
• Emily H. Stafslien, SLP
• Ervin Stedjee, PTA
• Karen Stern, H.I.S
• Stratton Drug Inc (Stratton Drug Store)
• Al Strobusch, MD

• Physical Therapist in Waupaca, WI
• Providers in Waupaca, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2008; 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.