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General NPI Number Information
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NPI Number | 1861289597
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Entity Type | Individual
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Provider Name | MATTHEW R PASCARELLA
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Gender | Male
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 118 HOMESTEAD DRIVE #1
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City | NEW RICHMOND, WISCONSIN
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State | WI
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Zip | 54017
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Country | US
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Telephone | 715-256-8724
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 174TH AVENUE
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City | NEW RICHMOND
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State | WI
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Zip | 54017-6335
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Country | US
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Telephone | 715-417-0745
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Fax | 715-417-0745
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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