Provider Demographics
NPI:1548322019
Name:INTEGRITY SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:INTEGRITY SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC,
Authorized Official - Phone:715-369-1001
Mailing Address - Street 1:1903 LINCOLN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3674
Mailing Address - Country:US
Mailing Address - Phone:715-369-1001
Mailing Address - Fax:715-369-1003
Practice Address - Street 1:1903 LINCOLN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3674
Practice Address - Country:US
Practice Address - Phone:715-369-1001
Practice Address - Fax:715-369-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62-0392255A2300X
WI434-0392255A2300X
WI4433-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDD7431OtherRAILROAD MEDICARE