Van Susteren, John R

Van Susteren, John R is an sole proprietor health care provider with primary practice located at 800 Geneva Pkwy N Suite 3, Lake Geneva WI 53147-5701. 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 Susteren, John R can be contacted via phone (262) 248-9902.

Contact Information

Primary practice address
800 Geneva Pkwy N Suite 3 Lake Geneva WI 53147-5701
Phone: (262) 248-9902
Fax: (262) 248-9419
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 4467024 Wisconsin

Profile Details

NPI number 1619192150
LBN Legal business name Van Susteren, John R
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 17th, 2007
Last updated Apr 5th, 2010 - about 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619192150 NPPES
Wisconsin MEDICAID 40316500
Wisconsin Other 11413052

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