Neil A Wahlstrom, PT, MBA

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5819-024 Issued in WI

Practice address

528 W Pine St
Eagle River, WI 54521-9083

Phone

(715) 477-1523

Fax

(715) 477-1524

NPI assigned

Nov 1, 2006

Last updated

Mar 6, 2009By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

State licenses

Practice roles

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.

• Diagnostic & Treatment Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Weston, WI
  • NPI 1659385540
  NPD (past)
• Diagnostic & Treatment Center, LLC

  • Clinical Medical Laboratory
  • Weston, WI
  • NPI 1740294636
  NPD (past)
• Health in Motion, LLC

  • Physical Therapist
  • Rhinelander, WI
  • NPI 1801838404
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236297600000",
    "number": "1780761411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 W PINE ST",
            "city": "EAGLE RIVER",
            "state": "WI",
            "postal_code": "545219083",
            "telephone_number": "715-477-1523",
            "fax_number": "715-477-1524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 W PINE ST",
            "city": "EAGLE RIVER",
            "state": "WI",
            "postal_code": "545219083",
            "telephone_number": "715-477-1523",
            "fax_number": "715-477-1524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLSTROM",
        "first_name": "NEIL",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PT, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2009-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "5819-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40302900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trans N Aviation/ Travel Care Intl.
• Edward Douglas Tsao, R.PH.
• Dennis J Vandermause, LCSW
• Vilas County Dept of Social Services
• Vitality Health Collaborative, LLC
• Walgreen Co (Walgreens #12545)
• Samantha Weber, DPT
• April Welch, BCBA
• Joshua Michael Welch, PHARMD
• Harry H Whidden, P.A

• Physical Therapist in Eagle River, WI
• Providers in Eagle River, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; 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.