| Organization Name: | SPORT & SPINE CLINIC LP |
| NPI Number: | 1699711630 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANNA P. KING (VP AUTHORIZED OFFICIAL) |
| Mailing Address: | 327 N 17th Ave Suite 7 Wausau |
| State: | WI US |
| Postal Code: | 544014225 |
| Phone Number: | 7158452942 |
| Fax Number: | 7158423416 |
| NPI Enumeration Date: | 06/20/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |