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Organization
SPINE AND SPORT PHYSICAL THERAPY OF WAUPACA LLC
Active
Organization
SPINE AND SPORT PHYSICAL THERAPY OF WAUPACA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL RAY KOCH P.T. (MEMBER)
(920) 538-3670
Entity
Organization
Contact information
Practice address
1439 CHURCHILL ST STE 102, WAUPACA, WI 54981-2089
(920) 538-3670
(715) 256-9404
Mailing address
1439 CHURCHILL ST STE 102, WAUPACA, WI 54981-2089
(920) 538-3670
(715) 256-9404
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/07/2008
Last updated
03/16/2008
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