Provider Demographics
NPI:1154776144
Name:THEUERKAUF, WESLEY DAVID
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:DAVID
Last Name:THEUERKAUF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8067 BRINKLAND DR
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9236
Mailing Address - Country:US
Mailing Address - Phone:715-892-3596
Mailing Address - Fax:
Practice Address - Street 1:8067 BRINKLAND DR
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9236
Practice Address - Country:US
Practice Address - Phone:715-892-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2236225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant