Provider Demographics
NPI:1275060121
Name:MATHSON, MICHAEL DAVID (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:MATHSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S EAGLE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-3716
Mailing Address - Country:US
Mailing Address - Phone:715-539-2740
Mailing Address - Fax:715-536-1814
Practice Address - Street 1:100 S EAGLE DR STE 2
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-3716
Practice Address - Country:US
Practice Address - Phone:715-539-2740
Practice Address - Fax:715-536-1814
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist