Provider Demographics
NPI:1285675926
Name:MATJE, NATHAN R (PT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:R
Last Name:MATJE
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Gender:M
Credentials:PT
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Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-544-5311
Mailing Address - Fax:262-544-6820
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-544-5311
Practice Address - Fax:262-544-6820
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI10627-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36114100Medicaid