SPINE AND SPORT PHYSICAL THERAPY OF WAUPACA LLC
NPI 1770768046
Physical Therapist in Waupaca, WI

Active since January 07, 2008
1439 CHURCHILL ST STE 102, WAUPACA, WI 54981(920) 538-3670(715) 256-9404 Get Directions Write a Review

NPPES record last updated: March 16, 2008. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Spine And Sport Physical Therapy Of Waupaca Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPINE AND SPORT PHYSICAL THERAPY OF WAUPACA LLC (NPI 1770768046) is a healthcare organization registered as a physical therapist in Waupaca, Wisconsin and active in the NPI registry since January 2008. The organization lists Michael Ray Koch, Member, as its authorized official.

NPPES Registry Identity

NPI1770768046
Entity TypeOrganization
Primary Taxonomy225100000X
Legal Business NameSPINE AND SPORT PHYSICAL THERAPY OF WAUPACA LLC
Location Address1439 CHURCHILL ST STE 102Waupaca, WI 54981-2089
Mailing Address1439 Churchill St Ste 102Waupaca, WI 54981-2089 · (920) 538-3670 · Fax (715) 256-9404
Fax(715) 256-9404
Organization SubpartNo
Authorized OfficialMichael Ray KochMember · (920) 538-3670
Enumeration DateJanuary 7, 2008
Last NPPES UpdateMarch 16, 2008
✔ NPI 1770768046 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225100000X
Definition
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.
1439 CHURCHILL ST STE 102, Waupaca, WI 54981

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Spine And Sport Physical Therapy Of Waupaca Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Spine And Sport Physical Therapy Of Waupaca LLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Physical Therapist in Private Practice
NPI 1225058878
1948 GODFREY DR
Waupaca, WI 54981
(715) 340-5383
✔ Accepts Medicare1.5 mi
Physical Therapist in Private Practice
NPI 1679820716
1948 GODFREY DR
Waupaca, WI 54981
(715) 258-7778
✔ Accepts Medicare1.5 mi
Physical Therapist in Private Practice
NPI 1548783228
1405 MILL ST
New London, WI 54961
(920) 531-2000
✔ Accepts Medicare17 mi
Physical Therapist in Private Practice
NPI 1316508807
2901 E ENTERPRISE AVE STE 600
Appleton, WI 54913
(920) 738-0671
35 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Spine And Sport Physical Therapy Of Waupaca LLC's NPI number?

The NPI number for Spine And Sport Physical Therapy Of Waupaca LLC is 1770768046. It was assigned to this organization in the NPPES registry on January 7, 2008.

Where is Spine And Sport Physical Therapy Of Waupaca LLC located?

Spine And Sport Physical Therapy Of Waupaca LLC is located at 1439 Churchill St Ste 102, Waupaca, WI 54981. The listed phone number is (920) 538-3670.

What is Spine And Sport Physical Therapy Of Waupaca LLC's specialty?

The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.

Is Spine And Sport Physical Therapy Of Waupaca LLC enrolled in Medicare?

Yes. Spine And Sport Physical Therapy Of Waupaca LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Spine And Sport Physical Therapy Of Waupaca LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Physical Therapist in Private Practice, reassign their Medicare billing to Spine And Sport Physical Therapy Of Waupaca LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Spine And Sport Physical Therapy Of Waupaca LLC accept?

Health plans from Anthem Blue Cross and Blue Shield and Security Health Plan list Spine And Sport Physical Therapy Of Waupaca LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Spine And Sport Physical Therapy Of Waupaca LLC was last updated on March 16, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.