Provider Demographics
NPI:1174852735
Name:PEDERSEN, ARIC J (PT, MPT)
Entity Type:Individual
Prefix:
First Name:ARIC
Middle Name:J
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S MAIN ST
Mailing Address - Street 2:VERNON MEMORIAL HOSPITAL
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-2059
Mailing Address - Country:US
Mailing Address - Phone:608-637-4385
Mailing Address - Fax:608-637-4382
Practice Address - Street 1:507 S MAIN ST
Practice Address - Street 2:VERNON MEMORIAL HOSPITAL
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-2059
Practice Address - Country:US
Practice Address - Phone:608-637-4385
Practice Address - Fax:608-637-4382
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9859-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist