Provider Demographics
NPI:1295894640
Name:MUCHENBERGER, RAE JEAN (PTA)
Entity type:Individual
Prefix:MRS
First Name:RAE JEAN
Middle Name:
Last Name:MUCHENBERGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13915 W BELOIT RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7545
Mailing Address - Country:US
Mailing Address - Phone:414-427-0130
Mailing Address - Fax:
Practice Address - Street 1:8802 W BECHER
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1628
Practice Address - Country:US
Practice Address - Phone:414-541-1118
Practice Address - Fax:414-541-3066
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15500242081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine