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1326456245
THEODORE VANDERMEUSE
PORTAGE, WI
NPI
1326456245
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist Athletic Trainer
Enumeration Date
2014-07-23
Last Update Date
2014-07-23
Business Address
THEODORE VANDERMEUSE ATC/LAT
2817 NEW PINERY RD
PORTAGE, WI 53901-9240
Phone number: 608-745-6290
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Mailing Address
THEODORE VANDERMEUSE ATC/LAT
2817 NEW PINERY RD
PORTAGE, WI 53901-9240
Phone number: 608-745-6290
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