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General NPI Number Information
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NPI Number | 1992297477
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Entity Type | Individual
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Provider Name | MATTHEW JANSSEN
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Gender | Male
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 333 PINE RIDGE BLVD
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City | WAUSAU
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State | WI
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Zip | 54401-4102
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Country | US
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Telephone | 715-847-2826
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Fax |
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Provider Business Mailing Address
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Address Line | 2833 SOO MARIE AVE
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City | STEVENS POINT
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State | WI
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Zip | 54481-4953
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Country | US
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Telephone | 715-570-4673
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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 | 14259-24
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License Number State | WI
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