Van De Water, Thomas D
Van De Water, Thomas D is an individual health care provider with primary practice located at 6222 Washington Ave , Mount Pleasant WI 53406-3948. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Van De Water, Thomas D can be contacted via phone (262) 884-6418.Contact Information
Primary practice address
6222 Washington Ave
Mount Pleasant WI 53406-3948
Phone: (262) 884-6418
Fax: (262) 884-6489
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 9812-024 | Wisconsin |
Profile Details
| NPI number | 1831257369 |
|---|---|
| LBN Legal business name | Van De Water, Thomas D |
| Credentials | Master of Physical Therapy (MPT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 5th, 2006 |
| Last updated | Dec 3rd, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831257369 | NPPES |
| Wisconsin | Other | 9812-024 | STATE LICENSE NUMBER |
| Wisconsin | MEDICAID | 36124700 | STATE LICENSE NUMBER |
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