Healthcare Provider Details

I. General information

NPI: 1518891753
Provider Name (Legal Business Name): SAMUEL H DORCHESTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 ROOSEVELT RD
MARINETTE WI
54143-3834
US

IV. Provider business mailing address

644 STAMBAUGH RD
GREEN BAY WI
54301-2630
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-4880
  • Fax:
Mailing address:
  • Phone: 920-241-1904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: