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General NPI Number Information
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NPI Number | 1821048844
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Entity Type | Individual
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Provider Name | MICHAEL JOHN SCANDIN PT LAT
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 16 E MENARD PLAZA
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City | WAUSAU
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State | WI
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Zip | 54401
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Country | US
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Telephone | 715-845-2942
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Fax | 715-842-3416
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Provider Business Mailing Address
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Address Line | PO BOX 1349 SPORT & SPINE CLINIC
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City | WAUSAU
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State | WI
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Zip | 54402-1349
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Country | US
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Telephone | 715-845-2942
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Fax | 715-842-3416
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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 | 3841024
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 540039
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License Number State | WI
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