Provider Demographics
NPI:1720107378
Name:NEUENFELDT, PAUL STEVEN (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:STEVEN
Last Name:NEUENFELDT
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 48TH ST
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-1015
Mailing Address - Country:US
Mailing Address - Phone:920-819-3494
Mailing Address - Fax:
Practice Address - Street 1:1400 WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3043
Practice Address - Country:US
Practice Address - Phone:920-553-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI872-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer