Provider Demographics
NPI:1558033720
Name:HEPPERLEN, MADELEINE BROOKE (DPT)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:BROOKE
Last Name:HEPPERLEN
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 1:2426 HENGEL CT APT 104
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7547
Mailing Address - Country:US
Mailing Address - Phone:815-382-2812
Mailing Address - Fax:
Practice Address - Street 1:407 S MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-2100
Practice Address - Country:US
Practice Address - Phone:608-637-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15629-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist