Healthcare Provider Details

I. General information

NPI: 1619910759
Provider Name (Legal Business Name): MAURICE DUMIT MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 N HUMBOLDT AVE SUITE 300
MILWAUKEE WI
53212-3504
US

IV. Provider business mailing address

2060 N. HUMBOLDT AVE SUITE 300
MILWUAKEE WI
53212
US

V. Phone/Fax

Practice location:
  • Phone: 414-265-5606
  • Fax: 414-265-5649
Mailing address:
  • Phone: 414-265-5606
  • Fax: 414-265-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6247024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: