Healthcare Provider Details

I. General information

NPI: 1699720060
Provider Name (Legal Business Name): CATHERINE MARY VAN LAANEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10412 N BAEHR RD
MEQUON WI
53092-4472
US

IV. Provider business mailing address

10412 N BAEHR RD
MEQUON WI
53092-4472
US

V. Phone/Fax

Practice location:
  • Phone: 262-236-0176
  • Fax: 262-236-0178
Mailing address:
  • Phone: 262-236-0176
  • Fax: 262-236-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9531-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: