Individual
MR. EDWARD V VAN DEWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT CSCS
Contact information
Practice address
6222 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3948
(262) 884-6418
(262) 884-6489
Mailing address
6222 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3948
(262) 884-6418
(262) 884-6489
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9822-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40407400
—
WI
01
—
9822-024
STATE LICENSE NUMBER
WI
Enumeration date
12/05/2006
Last updated
11/21/2021
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