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General NPI Number Information
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NPI Number | 1154283497
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Entity Type | Individual
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Provider Name | DOUG CHARLES DRALLE PT,DPT
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Gender | Male
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 3360 GATEWAY RD STE 100
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City | BROOKFIELD
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State | WI
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Zip | 53045-5115
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Country | US
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Telephone | 262-923-7101
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Fax |
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Provider Business Mailing Address
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Address Line | 7933 W CLARKE ST
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City | WAUWATOSA
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State | WI
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Zip | 53213-1146
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Country | US
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Telephone | 262-923-7101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 5183-24
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License Number State | WI
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