Provider Demographics
NPI:1801857727
Name:VAN VEGHEL, MICHAEL J (ATC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:VAN VEGHEL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 EAGAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3702
Mailing Address - Country:US
Mailing Address - Phone:608-265-1208
Mailing Address - Fax:608-263-2010
Practice Address - Street 1:1726 EAGAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3702
Practice Address - Country:US
Practice Address - Phone:608-265-1208
Practice Address - Fax:608-263-2010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI378-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer