Provider Demographics
NPI:1285105064
Name:WIBEL, MATHEW LEE (ABC CPED)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:LEE
Last Name:WIBEL
Suffix:
Gender:M
Credentials:ABC CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAINT CHARLES PL
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-2256
Mailing Address - Country:US
Mailing Address - Phone:715-307-9071
Mailing Address - Fax:
Practice Address - Street 1:3 SAINT CHARLES PL
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-2256
Practice Address - Country:US
Practice Address - Phone:715-307-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224L00000X
WI224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist