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General NPI Number Information
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NPI Number | 1639472756
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Entity Type | Organization
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Legal Business Name | JOHN T. DEMBOWIAK, LPT, S.C.
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Dates
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Enumeration Date | 12/11/2010
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Last Update Date | 12/11/2010
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Provider Practice Location Address
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Address Line | 5820 WASHINGTON AVE
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City | RACINE
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State | WI
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Zip | 53406-4020
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Country | US
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Telephone | 262-886-9887
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1664
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City | RACINE
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State | WI
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Zip | 53401-1664
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Country | US
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Telephone | 262-886-9887
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JOHN T DEMBOWIAK
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Credential | LPT
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Telephone | 262-886-9887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1330-24
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License Number State | WI
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