Provider Demographics
NPI:1134130164
Name:HEALTH MATTERS MUSCULAR THERAPY CLINIC, LLC
Entity Type:Organization
Organization Name:HEALTH MATTERS MUSCULAR THERAPY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ARNOLDUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:920-954-2068
Mailing Address - Street 1:821 E. FIRST AVENUE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1572
Mailing Address - Country:US
Mailing Address - Phone:920-954-2068
Mailing Address - Fax:920-882-5443
Practice Address - Street 1:821 E 1ST AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1501
Practice Address - Country:US
Practice Address - Phone:920-954-2068
Practice Address - Fax:920-882-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI254-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty