Provider Demographics
NPI:1437187135
Name:ORTHOPEDIC & SPINE THERAPY OF NEW LONDON, SC
Entity type:Organization
Organization Name:ORTHOPEDIC & SPINE THERAPY OF NEW LONDON, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:920-257-2000
Mailing Address - Street 1:4000 N. PROVIDENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2000
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:315 BURTON RD STE 107
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-1176
Practice Address - Country:US
Practice Address - Phone:920-982-3670
Practice Address - Fax:920-982-4273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI611271700OtherUS DEPARTMENT OF LABOR
WI40419300Medicaid
WI128857OtherHEALTH PARTNERS
WI2133174001OtherAMERICHOICE
WI41745700Medicaid
WICH3635OtherRAILROAD MEDICARE
WI40419300Medicaid
WI128857OtherHEALTH PARTNERS
WI41745700Medicaid
WI000086015Medicare ID - Type Unspecified