Healthcare Provider Details

I. General information

NPI: 1982959250
Provider Name (Legal Business Name): MATTHEW J UECKER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W PARADISE DR
WEST BEND WI
53095-9795
US

IV. Provider business mailing address

1700 W PARADISE DR
WEST BEND WI
53095-9795
US

V. Phone/Fax

Practice location:
  • Phone: 262-334-3451
  • Fax: 262-334-0041
Mailing address:
  • Phone: 262-334-3451
  • Fax: 262-334-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12086
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: