Healthcare Provider Details

I. General information

NPI: 1134130164
Provider Name (Legal Business Name): HEALTH MATTERS MUSCULAR THERAPY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E 1ST AVE SUITE #4
APPLETON WI
54911-1501
US

IV. Provider business mailing address

821 E. FIRST AVENUE SUITE #4
APPLETON WI
54911-1572
US

V. Phone/Fax

Practice location:
  • Phone: 920-954-2068
  • Fax: 920-882-5443
Mailing address:
  • Phone: 920-954-2068
  • Fax: 920-882-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number254-046
License Number StateWI

VIII. Authorized Official

Name: MS. HEIDI ROSE ARNOLDUSSEN
Title or Position: OWNER
Credential: LMT
Phone: 920-954-2068