Individual
MR. JASON MATTHEW WOLBERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
201 S PARK AVE, FRIENDSHIP, WI 53934-9377
(608) 339-3361
Mailing address
5 N KENOSHA DR, MADISON, WI 53705-2630
(608) 279-5625
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6457-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40336800
—
WI
Enumeration date
05/15/2007
Last updated
07/09/2007
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