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General NPI Number Information
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NPI Number | 1558033720
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Entity Type | Individual
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Provider Name | MADELEINE BROOKE HEPPERLEN DPT
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Gender | Female
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 407 S MAIN ST STE 302
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City | VIROQUA
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State | WI
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Zip | 54665-2100
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Country | US
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Telephone | 608-637-4385
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Fax |
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Provider Business Mailing Address
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Address Line | 2426 HENGEL CT APT 104
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City | LA CROSSE
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State | WI
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Zip | 54601-7547
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Country | US
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Telephone | 815-382-2812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15629-24
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License Number State | WI
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