Provider Demographics
NPI:1982021176
Name:PATZKE, MATTHEW F (LAT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:F
Last Name:PATZKE
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 SPRING STREET SUITE 102
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405
Mailing Address - Country:US
Mailing Address - Phone:262-687-5866
Mailing Address - Fax:262-687-5895
Practice Address - Street 1:3811 SPRING STREET SUITE 102
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405
Practice Address - Country:US
Practice Address - Phone:262-687-5866
Practice Address - Fax:262-687-5895
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1340-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1340-39OtherSTATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES