Provider Demographics
NPI:1205020682
Name:VERSTEGEN, PHILIP JOSEPH
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:VERSTEGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 SWIFT AVE # 116
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-6039
Mailing Address - Country:US
Mailing Address - Phone:920-226-8022
Mailing Address - Fax:
Practice Address - Street 1:641 SWIFT AVE # 116
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6039
Practice Address - Country:US
Practice Address - Phone:920-226-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5290261QP2000X
WIPT2066261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy