Individual
MATTHEW MUSSALLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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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