Individual
MATTHEW MUSSALLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-8025
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10703
WI
2251X0800X
Orthopedic Physical Therapist
10703-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36119500
—
WI
01
—
877039
ATHLETIC TRAINING LICENSE
WI
Enumeration date
12/06/2006
Last updated
01/25/2023
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