Provider Demographics
NPI:1952418816
Name:ORTHOPEDIC & SPINE THERAPY OF OSHKOSH SC
Entity type:Organization
Organization Name:ORTHOPEDIC & SPINE THERAPY OF OSHKOSH SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-257-2000
Mailing Address - Street 1:1000 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1116
Mailing Address - Country:US
Mailing Address - Phone:920-257-2000
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:515 S WASHBURN ST STE 100
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7951
Practice Address - Country:US
Practice Address - Phone:920-232-4040
Practice Address - Fax:920-232-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41745300Medicaid
WI369949305OtherUS DEPARTMENT OF LABOR
WI4136293002OtherAMERICHOICE
WI128848OtherHEALTH PARTNERS
WICH3433OtherRAILROAD MEDICARE
WI40416700Medicaid
WICH3433OtherRAILROAD MEDICARE
WI41745300Medicaid
WI41745300Medicaid