Individual
MATTHEW STEVEN BLIEVERNICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
N15W28300 GOLF RD, PEWAUKEE, WI 53072-4800
(262) 303-5055
(262) 303-5057
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11016
WI
225100000X
Physical Therapist
5973
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0252231
WASHINGTON L&I
OR
05
—
100257659
—
WI
05
—
100298600
—
WI
05
—
500609437
—
OR
01
—
P00802449
RR MEDICARE
OR
Enumeration date
05/30/2008
Last updated
01/07/2025
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