Provider Demographics
NPI:1083833735
Name:WIER, DONALD A (PT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:WIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 OMRO RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7125
Mailing Address - Country:US
Mailing Address - Phone:920-233-7177
Mailing Address - Fax:
Practice Address - Street 1:3475 OMRO RD
Practice Address - Street 2:STE. 300
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7125
Practice Address - Country:US
Practice Address - Phone:920-233-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3756-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40169500Medicaid
WI40169500Medicaid