Healthcare Provider Details

I. General information

NPI: 1003943572
Provider Name (Legal Business Name): DENNIS CHESTER SOBUSH PT, MA, DPT, CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 S 120TH ST
GREENFIELD WI
53228-1882
US

IV. Provider business mailing address

3920 S 120TH ST
GREENFIELD WI
53228-1882
US

V. Phone/Fax

Practice location:
  • Phone: 414-546-2667
  • Fax:
Mailing address:
  • Phone: 414-546-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number1436-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: