Provider Demographics
NPI:1700970217
Name:WAECKERLE, CATHY A (PT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:WAECKERLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 N. STEVENS ST.
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-0646
Mailing Address - Country:US
Mailing Address - Phone:715-369-0462
Mailing Address - Fax:
Practice Address - Street 1:1880 N.STEVENS ST.
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-0646
Practice Address - Country:US
Practice Address - Phone:715-369-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40120400Medicaid