Healthcare Provider Details

I. General information

NPI: 1477484103
Provider Name (Legal Business Name): JARED ROBERT DVORAK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 BRATLEY DR
WASHBURN WI
54891-1143
US

IV. Provider business mailing address

W9085 COUNTY ROAD A
NEW LISBON WI
53950-9753
US

V. Phone/Fax

Practice location:
  • Phone: 704-862-4755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: