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NPI Code Detail

MEDICARE: MR. NATHAN R MATJE PT

MEDICARE: MR. NATHAN R MATJE PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10627-024WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285675926
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NATHAN R MATJE PT
Provider Business Mailing Address
First Line : W225N16711 CEDAR PARK CT
Second Line :
City : JACKSON
State : WI
Zip : 53037-9222
Country : US
Telephone Number : 262-677-1101
Fax Number : 262-677-0121
Provider Business Practice Location Address
First Line : W225N16711 CEDAR PARK CT
Second Line :
City : JACKSON
State : WI
Zip : 53037-9222
Country : US
Telephone Number : 262-677-1101
Fax Number : 262-677-0121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 11/04/2025

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