Provider Demographics
NPI:1760676183
Name:OSTERBERG, RICHARD DON (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DON
Last Name:OSTERBERG
Suffix:
Gender:M
Credentials:PT
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 12534
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-2534
Mailing Address - Country:US
Mailing Address - Phone:920-434-0873
Mailing Address - Fax:920-336-0405
Practice Address - Street 1:2052 PINECONE CR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313
Practice Address - Country:US
Practice Address - Phone:920-434-0873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI449024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist