| Provider / Organization | NPI | Date Certified |
|---|---|---|
| EDWARD V VAN DEWATER | 1083772529 | 2021-11-21 |
Edward V Van De Water PT [M] graduated in 2001 and primarily specializes in Physical Therapy.
Edward V Van Dewater is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1083772529. Registration indicates Edward V Van Dewater is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Physical Therapist (Physical Therapist, ) (Speech/Occupational/Physical Therapy/Chiropractor, ) (Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers)
| PECOS ID | 2062316979 |
| Entity Type | Individual |
| Provider Name | Mr. Edward V Van Dewater MPT CSCS |
| Practice Office Address | 6222 WASHINGTON AVE MOUNT PLEASANT, WI US |
| Practice Office Telephone | 2628846418 |
| Practice Office Fax | 2628846489 |
| Mailing Address | 6222 WASHINGTON AVE MOUNT PLEASANT, WI 534063948 US |
| Business Telephone | 2628846418 |
| Business Fax | 2628846489 |
| Code | Practice | License No State |
|---|---|---|
| 225100000X PRIMARY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist Physical Therapist Speech/Occupational/Physical Therapy/Chiropractor Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers | 9822-024
WI |
| 40407400 | MEDICAID | WI | |
| 9822-024 | OTHER | WI | STATE LICENSE N |