Individual provider Active NPI

Matthew D Haberl, PT

  • Physical Therapist
  • La Crosse, WI
National Provider Identifier
1366693285
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11051-24 Issued in WI
Practice address
700 West Ave S
La Crosse, WI 54601-4783
Phone
(715) 838-3635
NPI assigned
Oct 9, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11051-24 WI Primary

Addresses

Primary practice location

700 West Ave S
La Crosse, WI 54601-4783

Mailing address

PO Box 1510
Eau Claire, WI 54702-1510
Phone (715) 838-3635

Other practice location 1

3111 Gundersen Dr
Onalaska, WI 54650-8447
Phone (608) 782-7300

Other identifiers 2

IdentifierTypeStateIssuer
11051-24OtherWIWISCONSIN STATE LICENSE PT
773-039OtherWIWISCONSIN LICENSE ATHLETIC TRAINER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110215000620 WI Practitioner - Physical Therapist in Private Practice 8426238932 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dynamic PT LLCGroup PAC ID 3779948302, 9 clinicians

Practice addresses (Care Compare)

1430 Main St
Onalaska, WI 54650-2835
Phone (608) 351-3049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11051-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Medical Center Inc CurrentSince Jun 1, 2013 Accepting new patients
Gundersen Clinic LTD Current Accepting new patients
Gundersen Lutheran Express Care, Inc CurrentSince Oct 12, 2010 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Jun 1, 2013 Accepting new patients
Dynamic PT LLC Physical Therapist CurrentSince Nov 15, 2022 Accepting new patients
Gundersen Clinic LTD CurrentSince Oct 12, 2010 Accepting new patients
Roberts & Associates Physical Therapy SC Physical Therapist CurrentSince Oct 5, 2017 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Roberts & Associates Physical Therapy SC PastSince Dec 10, 2023 Accepting new patients

Locations

700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

2841 Darling Ct
La Crosse, WI 54601
Phone (608) 351-3049

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

1430 Main St
Onalaska, WI 54650
Phone (608) 351-3049

3111 Gundersen Dr
Onalaska, WI 54650
Phone (608) 775-8100

705 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 357-2000

310 W Main St
Sparta, WI 54656
Phone (608) 269-1700

621 8th St S
Wisconsin Rapids, WI 54494
Phone (715) 529-3487

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1366693285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547021510",
            "telephone_number": "715-838-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WEST AVE S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546014783",
            "telephone_number": "715-838-3635"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3111 Gundersen Dr",
            "address_purpose": "LOCATION",
            "city": "Onalaska",
            "state": "WI",
            "postal_code": "546508447",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HABERL",
        "first_name": "MATTHEW",
        "middle_name": "D",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11051-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN STATE LICENSE PT",
            "identifier": "11051-24",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN LICENSE ATHLETIC TRAINER",
            "identifier": "773-039",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.