Provider Demographics
NPI:1528494663
Name:WOUTERS, ISAAC I (PT)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:I
Last Name:WOUTERS
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 1:814 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1520
Mailing Address - Country:US
Mailing Address - Phone:608-873-6448
Mailing Address - Fax:608-646-0497
Practice Address - Street 1:814 JACKSON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1520
Practice Address - Country:US
Practice Address - Phone:608-873-6448
Practice Address - Fax:608-646-0497
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12517-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist