Provider Demographics
NPI:1396911335
Name:MATUSZAK, JANET A (PT)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:A
Last Name:MATUSZAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:964 W RYAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1076
Practice Address - Country:US
Practice Address - Phone:920-756-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5846-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40326300Medicaid
WI100200070Medicare Oscar/Certification
WI000286165Medicare PIN