Frederick A Mathwig, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1406024 Issued in WI

Practice address

5409 Everybodys Road
Forest County Potawatomi Health & Wellness Center
Crandon, WI 54520

Phone

(715) 478-4300

Fax

(715) 478-4490

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407864382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 396",
            "address_2": "5409 EVERYBODYS ROAD FOREST COUNTY POTAWATOMI HEALTH &",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "54520",
            "telephone_number": "715-478-4300",
            "fax_number": "715-478-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5409 EVERYBODYS ROAD",
            "address_2": "FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "54520",
            "telephone_number": "715-478-4300",
            "fax_number": "715-478-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHWIG",
        "first_name": "FREDERICK",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "1406024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURITY HEALTH PLAN",
            "identifier": "70738",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40005100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Krzmarcik, SAC-IT
• Amy Susan Kuebler, APNP
• Amanda C Lallensack, OD
• Jessica Linderud, PHARMD
• Dakota Ann Malzewski, DC
• Lynette M McCorkle, LPC
• Laura L Meverden, APNP
• Mide Inc.
• Karen A Minx, SAC
• Susan Elisabeth Moore, MD

• Physical Therapist in Crandon, WI
• Providers in Crandon, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.