Matthew Wilfuer, ATC, LAT – Athletic Trainer

Key facts

NPI: 1497125348
Entity type: Individual (NPI type 1)
Primary specialty: Athletic Trainer 2255A2300X
License: 079020 (IA)
Practice address: 605 Washington St
Fayette, IA 52142-9206
Phone: (563) 425-5364
NPI assigned: Oct 5, 2015
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
079020	IA	MD	Athletic Trainer

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Athletic Trainer	2255A2300X	079020	IA	Yes

Addresses

Primary practice location

605 Washington St
Fayette, IA 52142-9206

Mailing address

E9033 Worm Rd
New London, WI 54961-8463
Phone (920) 359-0224

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 12, 2016.

{
    "created_epoch": "1444003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1497125348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "E9033 WORM RD",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549618463",
            "telephone_number": "920-359-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 WASHINGTON ST",
            "city": "FAYETTE",
            "state": "IA",
            "postal_code": "521429206",
            "telephone_number": "563-425-5364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILFUER",
        "first_name": "MATTHEW",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-05",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IA",
            "license": "079020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayette, IA

All providers in Fayette, IA · Athletic Trainer in Iowa

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2016. 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.

Verify at the official NPI Registry.