Healthcare Provider Details

I. General information

NPI: 1003745597
Provider Name (Legal Business Name): BRYTON MAUPIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E CAPITOL DR
APPLETON WI
54911-8728
US

IV. Provider business mailing address

3000 E LOURDES DR
APPLETON WI
54915-3937
US

V. Phone/Fax

Practice location:
  • Phone: 920-454-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: