Provider Demographics
NPI:1831142892
Name:MATHESON, JAMES WALTER (PT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALTER
Last Name:MATHESON
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 1:1830 HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9368
Mailing Address - Country:US
Mailing Address - Phone:715-386-1155
Mailing Address - Fax:715-386-1105
Practice Address - Street 1:1830 HANLEY RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9368
Practice Address - Country:US
Practice Address - Phone:715-386-1155
Practice Address - Fax:715-386-1105
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5899225100000X
WI6187-242251X0800X
WI6187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP49341OtherHEALTHPARTNERS
64-10404OtherMEDICA
MNHP49341OtherHEALTHPARTNERS
1831142892OtherAM PPO
B17211054965OtherPREFERRED ONE
64-10404OtherMEDICA