# ORTHO SPORT & SPINE PHYSICIANS OF WISCONSIN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760190243
- **Authorized official:** FAITH BELTZHOOVER (REVENUE CYCLE MANAGEMENT DIRECTOR)
- **Authorized official phone:** (678) 752-7246

## Contact information

- **Practice address:** 2500 N MAYFAIR RD STE 440, WAUWATOSA, WI 53226-1415
- **Practice address phone:** (678) 752-7246
- **Mailing address:** 5788 ROSWELL RD, ATLANTA, GA 30328-4904
- **Mailing address phone:** (678) 752-7246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/14/2022
- **Last updated:** 11/14/2022