Provider Demographics
NPI:1487828273
Name:DENNIS, DEBORAH JANE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JANE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S KLEIN DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1575
Mailing Address - Country:US
Mailing Address - Phone:608-849-5016
Mailing Address - Fax:608-850-6878
Practice Address - Street 1:801 S KLEIN DR
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1575
Practice Address - Country:US
Practice Address - Phone:608-849-5016
Practice Address - Fax:608-850-6878
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40057300Medicaid