Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 6034 | WI |
N | 2251S0007X | Physical Therapist - Sports | 6034 | WI |
N | 2251X0800X | Physical Therapist - Orthopedic | 6034 | WI |
NPI | 1396720900 |
---|---|
Provider Name | Brian L Muehlbauer |
First Address | Sheboygan, WI 53083-4932 |
Second Address | Sheboygan, WI 53083-4932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q07310 | (02) | WI |