Individual
MICHELLE L. LANDSVERK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3232 N BALLARD RD STE 204, APPLETON, WI 54911-8804
(920) 729-7105
Mailing address
5485 W GRANDE MARKET DR STE C, APPLETON, WI 54913-8430
(920) 729-7105
(920) 257-2004
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5068-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000186035
MEDICARE
WI
01
—
001886030
MEDICARE
WI
05
—
40286800
—
WI
01
—
650019399
RAILROAD MEDICARE
WI
Enumeration date
08/16/2006
Last updated
02/07/2022
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