Provider Demographics
NPI:1275085227
Name:GUSSEL, LAUREN CATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CATHERINE
Last Name:GUSSEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N897 1ST RD
Mailing Address - Street 2:
Mailing Address - City:BRIGGSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53920-9723
Mailing Address - Country:US
Mailing Address - Phone:608-963-4540
Mailing Address - Fax:
Practice Address - Street 1:N897 1ST RD
Practice Address - Street 2:
Practice Address - City:BRIGGSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53920-9723
Practice Address - Country:US
Practice Address - Phone:608-963-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist