Doctor Name: | MR. MATTHEW J VANDERKOOI |
NPI Number: | 1932180775 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 5434 |
Business Practice Address: | 2639 New Pinery Rd Suite 2 Portage, WI - 539011110 |
Business Phone Number: | 6087429356 |
Business Fax Number: | 6087429358 |
Mailing Address: | 2639 New Pinery Rd, Suite 2 PORTAGE |
State: | WI |
Postal Code: | 539011110 |
Phone Number: | 6087429356 |
Fax Number: | 6087429358 |
NPI Enumeration Date: | 11/09/2005 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 5434 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |