Provider Demographics
NPI:1912084070
Name:ANTIGO TOTAL THERAPY & SPORTS REHAB CENTER INC
Entity type:Organization
Organization Name:ANTIGO TOTAL THERAPY & SPORTS REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHERMETZLN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:715-623-2292
Mailing Address - Street 1:720 ADDEY STREET
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409
Mailing Address - Country:US
Mailing Address - Phone:715-623-2292
Mailing Address - Fax:715-627-2660
Practice Address - Street 1:720 ASKLEY STREET
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409
Practice Address - Country:US
Practice Address - Phone:715-623-2292
Practice Address - Fax:715-627-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41221800Medicaid