Basic Information
| Provider Information | |||||||||
| NPI: | 1588096663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABOURIN | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620A SAINT PAUL ST | ||||||||
| Address2: | |||||||||
| City: | KIEL | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530421044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209055622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 916 E CLIFFORD ST | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530732468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208934777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 07/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12393-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.