Provider Demographics
NPI:1497125348
Name:WILFUER, MATTHEW (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:WILFUER
Suffix:
Gender:M
Credentials: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:E9033 WORM RD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-8463
Mailing Address - Country:US
Mailing Address - Phone:920-359-0224
Mailing Address - Fax:
Practice Address - Street 1:605 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-9206
Practice Address - Country:US
Practice Address - Phone:563-425-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0790202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer