Provider Demographics
NPI:1639873953
Name:MUELLER, MATT L
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:L
Last Name:MUELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MATT
Other - Middle Name:L
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:812 BROUGHTON DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4115
Mailing Address - Country:US
Mailing Address - Phone:920-451-8000
Mailing Address - Fax:920-451-8019
Practice Address - Street 1:812 BROUGHTON DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4115
Practice Address - Country:US
Practice Address - Phone:920-451-8000
Practice Address - Fax:920-451-8019
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WINONE171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach