Healthcare Provider Details

I. General information

NPI: 1174898183
Provider Name (Legal Business Name): MADELINE M VAASSEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 09/14/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9843 KATIE CV
DUBUQUE IA
52003-8476
US

IV. Provider business mailing address

9843 KATIE CV
DUBUQUE IA
52003-8476
US

V. Phone/Fax

Practice location:
  • Phone: 563-663-7004
  • Fax:
Mailing address:
  • Phone: 563-663-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6342-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: