Provider Demographics
NPI:1376058495
Name:MATTSON, DEVIN JAMES (DPT, ATC/LAT)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:JAMES
Last Name:MATTSON
Suffix:
Gender:M
Credentials:DPT, ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-0511
Mailing Address - Country:US
Mailing Address - Phone:715-423-4442
Mailing Address - Fax:715-423-4491
Practice Address - Street 1:809 W NORTH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:WI
Practice Address - Zip Code:54966
Practice Address - Country:US
Practice Address - Phone:715-335-4446
Practice Address - Fax:715-335-4456
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist