Provider Demographics
NPI:1003875444
Name:OSTERMEIER, JOAN D (PT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:D
Last Name:OSTERMEIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8683 COUNTY RD AA
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409
Mailing Address - Country:US
Mailing Address - Phone:715-623-4470
Mailing Address - Fax:715-623-4470
Practice Address - Street 1:105 N GENESEE ST
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499
Practice Address - Country:US
Practice Address - Phone:715-253-2939
Practice Address - Fax:715-253-2930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1668024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40085300Medicaid
WI40306200Medicaid
526574Medicare ID - Type Unspecified