Healthcare Provider Details

I. General information

NPI: 1285675926
Provider Name (Legal Business Name): NATHAN R MATJE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W225N16711 CEDAR PARK CT
JACKSON WI
53037-9222
US

IV. Provider business mailing address

W225N16711 CEDAR PARK CT
JACKSON WI
53037-9222
US

V. Phone/Fax

Practice location:
  • Phone: 262-677-1101
  • Fax: 262-677-0121
Mailing address:
  • Phone: 262-677-1101
  • Fax: 262-677-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10627-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: