Spine and Sport Physical Therapy of Waupaca LLC
NPI 1770768046ActiveOrganization· Physical Therapist· Waupaca, WI
Physical Therapist in Waupaca, Wisconsin, registered in NPPES in January 2008. The authorized official on file is Michael Ray Koch, P.T., Member. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1770768046 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 7, 2008 |
| Last updated in NPPES | Mar 16, 2008 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (WI) |
|---|
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