Richard J. Deaver, P.T.
Individual provider Active NPI Physical Therapist · Three Lakes, WI
NPI 1255508917 · NPPES record last updated May 13, 2008
Key facts
- NPI
- 1255508917
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 963-024 (WI)
- Practice address
- 7754 Braeger Rd
Three Lakes, WI 54562-9207 - Phone
- (715) 546-8026
- NPI assigned
- May 13, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 963-024 | WI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 963-024 | WI | Yes |
Addresses
Primary practice location
7754 Braeger Rd
Three Lakes, WI 54562-9207
Mailing address
7754 1 Braeger Rd
Three Lakes, WI 54562-9207
Phone (715) 546-8026
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40100700 | Medicaid | WI |
Other providers in Three Lakes, WI
- Ascension Sacred Heart - St Mary'S Hospitals, Inc.
- Aspirus Medical Group, Inc.
- Bethany Cervenansky
- Natalie Grace Craig
- DJH Inc
- Linden Fraser
- Elizabeth A Kuhn
- Lakes Dental Services, Inc.
- Linderud Apothecaries LLC
All providers in Three Lakes, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.