Provider Demographics
NPI:1114306875
Name:ONSRUD, MICHAEL E (PTA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:ONSRUD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 MOUND ST
Mailing Address - Street 2:APT 307
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1531
Mailing Address - Country:US
Mailing Address - Phone:608-852-3541
Mailing Address - Fax:
Practice Address - Street 1:1020 HILL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3016
Practice Address - Country:US
Practice Address - Phone:920-261-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2257-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1629071121Medicaid