Organization
ADVANCED SPINE AND SPORT
Active
Other names
Advanced Spine and Sport Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS D VAN DE WATER MPT (MANAGING PARTNER)
(262) 884-6418
Entity
Organization
Contact information
Practice address
6222 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3948
(262) 884-6418
(262) 884-6489
Mailing address
6222 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3948
(262) 884-6418
(262) 884-6489
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40427900
—
WI
Enumeration date
12/05/2006
Last updated
01/13/2024
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