Provider Demographics
NPI:1083928717
Name:WANGSNESS, MICHAEL J (DPT, ATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:WANGSNESS
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Gender:M
Credentials:DPT, ATC
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Mailing Address - Street 1:471 S ARCH AVE
Mailing Address - Street 2:DADEZ PHYSICAL THERAPY, INC
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1832
Mailing Address - Country:US
Mailing Address - Phone:715-246-3809
Mailing Address - Fax:715-246-7139
Practice Address - Street 1:471 S ARCH AVE
Practice Address - Street 2:DADEZ PHYSICAL THERAPY, INC
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1832
Practice Address - Country:US
Practice Address - Phone:715-246-3809
Practice Address - Fax:715-246-7139
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2013-06-26
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC6263225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist