Provider Demographics
NPI:1598860561
Name:MUELLER, MICHELLE A
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:MUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 SPARKS RD
Mailing Address - Street 2:P.O. BOX 882
Mailing Address - City:LAND O' LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54540
Mailing Address - Country:US
Mailing Address - Phone:715-617-5432
Mailing Address - Fax:715-545-2508
Practice Address - Street 1:2251 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-6710
Practice Address - Country:US
Practice Address - Phone:715-361-2300
Practice Address - Fax:715-361-2877
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI591019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40358800Medicaid