PARK CITY PEDORTHICS (NPI# 1407492671) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407492671 |
| Entity Type | Organization |
| Organization Name | PARK CITY PEDORTHICS |
| Practice Address |
902 E 1st St Merrill WI 54452-2508 |
| Practice Telephone | 7152035730 |
| Mailing Telephone | 7152035730 |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2020-01-23 |
| Authorized Official Name | MS. TASHA GLEASON (OWNER) |
| Authorized Official Telephone | 7152035730 |
| Authorized Official Credential | C.PED |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 224L00000X | Pedorthist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
902 E 1ST ST |
| City | MERRILL |
| State | WI |
| Zip Code | 54452-2508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427616242 | Tasha Marie Gleason | Pedorthist | 902 E 1st St, Merrill, WI 54452-2508 | 2019-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184273799 | Bone & Joint Clinic S.c. | Durable Medical Equipment & Medical Supplies | 100 Eagle Drive, Merrill, WI 54452 | 2019-09-06 |
| 1215413893 | Justine Tolles | Speech-Language Pathologist | Pine Crest, 2100 E 6th St, Merrill, WI 54452 | 2018-07-17 |
| 1265723688 | Primary Connection Health Care, Inc | Clinic/Center | 401 W. Main Street, Merrill, WI 54452 | 2011-04-20 |
| 1134374192 | Amanda J Wanta | Dental Hygienist | 401 West Mail Street, Merrill, WI 54452 | 2008-11-18 |
| 1457528598 | Lincoln County 51.437 Services | Case Management | 912 N Memorial Dr, Merrill, WI 54452 | 2008-05-08 |
| 1003019522 | Mary Margaret Hintze | Nurse Anesthetist, Certified Registered | 621 South Center Avenue, Merrill, WI 54452 | 2007-06-11 |
| 1093860702 | Katherine M. Gress-volpentesta | Chiropractor | 109 A S Center Ave, Merrill, WI 54452 | 2007-01-24 |
| 1578618187 | Gress Chiropractic Clinic, LLC | Chiropractor | 109 A S. Center Ave., Merrill, WI 54452 | 2007-01-24 |
| 1487751939 | Roger S Lamoreux | Optometrist | 728 E 2nd St, Merrill, WI 54452 | 2006-09-19 |
| 1568566776 | Paula K Mcintyre | Dietitian, Registered | 1205 Oday St, Merrill, WI 54452 | 2006-09-08 |
| Find all providers in zip 54452 | ||||
| Taxonomy Code | 224L00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Pedorthist |
| An individual who is trained in the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices. |
| Notes: Source: National Uniform Claim Committee [7/1/2010: new] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427616242 | Tasha Marie Gleason | Pedorthist | 902 E 1st St, Merrill, WI 54452-2508 | 2019-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285105064 | Mathew Lee Wibel | Pedorthist | 3 Saint Charles Pl, Little Chute, WI 54140-2256 | 2018-12-05 |
| 1417492679 | Robert Mc Roberts Jr. | Pedorthist | 1706 York St Ste 3, Bloomer, WI 54724-1921 | 2016-12-27 |
| 1932640414 | Kathy Karrels | Pedorthist | 2475 N 124th St, Brookfield, WI 53005-4630 | 2017-03-16 |
| 1366983843 | Dennis Janisse | Pedorthist | 2475 N 124th St, Brookfield, WI 53005-4630 | 2017-03-16 |
| 1447705033 | James Blackmer | Pedorthist | 600 Highland Ave, Madison, WI 53792-0001 | 2016-08-24 |
| 1124338462 | Genevieve Pressman | Pedorthist | 200 S Executive Dr, Suite 101, Brookfield, WI 53005-4216 | 2010-10-20 |
Please comment or provide details below to improve the information on PARK CITY PEDORTHICS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.