Individual
JOHN R VAN SUSTEREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
800 GENEVA PKWY N, SUITE 3, LAKE GENEVA, WI 53147-5701
(262) 248-9902
(262) 248-9419
Mailing address
800 GENEVA PKWY N, SUITE 3, LAKE GENEVA, WI 53147-5701
(262) 248-9902
(262) 248-9419
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4467024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11413052
CAQH
WI
05
—
40316500
—
WI
Enumeration date
04/17/2007
Last updated
04/05/2010
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