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(INACTIVE)LMC CLUB HOUSE PT, OT
Complete NPI Record 1215194907
Physical Therapist in Rice Lake, WI

NPI Status: Active since May 20, 2008

Contact Information

1100 N MAIN ST
RICE LAKE, WI
ZIP 54868
Phone: (715) 234-1515
Fax: (715) 234-4465

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Provider License Number 1
  29. Provider License Number State Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Healthcare Provider Taxonomy Code 2
  32. Healthcare Provider Primary Taxonomy Switch 2
  33. Healthcare Provider Taxonomy Code 3
  34. Provider License Number 3
  35. Provider License Number State Code 3
  36. Healthcare Provider Primary Taxonomy Switch 3
  37. Other Provider Identifier 1
  38. Other Provider Identifier Type Code 1
  39. Other Provider Identifier State 1
  40. Is Organization Subpart
  41. Authorized Official Name Prefix Text
  42. Healthcare Provider Taxonomy Group 1
  43. Healthcare Provider Taxonomy Group 2
  44. Healthcare Provider Taxonomy Group 3
  45. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1215194907. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1215194907
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: (INACTIVE)LMC CLUB HOUSE PT, OT
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 1100 N MAIN ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: RICE LAKE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: WI
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Mailing Address Postal Code: 548681238
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7152341515
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 7152344465
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1100 N MAIN ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: RICE LAKE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: WI
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 548681238
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7152341515
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7152344465
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/20/2008
The city name in the location address of the provider being identified.
Last Update Date: 11/20/2024
The State code in the location of the provider being identified.
Authorized Official Last Name: KLEIN
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Authorized Official First Name: JACQUELINE
The country code in the location address of the provider being identified.
Authorized Official Title or Position: CFO
The telephone number associated with the location address of the provider being identified.
Authorized Official Telephone Number: 7152366129
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 225100000X
The date the provider was assigned a unique identifier (assigned an NPI).
Provider License Number 1: 1562800
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider License Number State Code 1: WI
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Healthcare Provider Primary Taxonomy Switch 1: Y
The first name of the authorized official.
Healthcare Provider Taxonomy Code 2: 225X00000X
The middle name of the authorized official.
Healthcare Provider Primary Taxonomy Switch 2: N
The title or position of the authorized official.
Healthcare Provider Taxonomy Code 3: 235Z00000X
The 10-position telephone number of the authorized official.
Provider License Number 3: 1562800
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 3: WI
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Healthcare Provider Primary Taxonomy Switch 3: N
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Other Provider Identifier 1: 41214500
The code designating the provider’s gender if the provider is a person.
Other Provider Identifier Type Code 1: 05
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Other Provider Identifier State 1: WI
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Is Organization Subpart: N
Authorized Official Name Prefix Text: MS.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 11/20/2024