Individual
MR. MATTHEW J VANDERKOOI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2639 NEW PINERY RD, SUITE 2, PORTAGE, WI 53901-1110
(608) 742-9356
(608) 742-9358
Mailing address
2639 NEW PINERY RD, SUITE 2, PORTAGE, WI 53901-1110
(608) 742-9356
(608) 742-9358
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5434
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40377900
—
WI
01
—
P00230916
RAILROAD MEDICARE INDIV #
WI
Enumeration date
11/09/2005
Last updated
07/09/2007
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