Spine and Sport Physical Therapy of Waupaca LLC

NPI #1770768046 in Waupaca, Wisconsin

Provider Information

NPI Number: 1770768046
Entity Type: Organization
Organization Name: Spine and Sport Physical Therapy of Waupaca LLC
Primary Specialty: Physical Therapist
Enumeration Date: Jan 7, 2008
Last Updated: Mar 16, 2008

Practice Location

Address: 1439 CHURCHILL ST STE 102
City: Waupaca
State: Wisconsin
ZIP Code: 54981-2089
Phone: (920) 538-3670

Authorized Official

Name: MR. MICHAEL RAY KOCH, P.T.
Title: MEMBER
Phone: (920) 538-3670

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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