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General NPI Number Information
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NPI Number | 1790422863
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Entity Type | Individual
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Provider Name | JUSTIN DAVID DOLFIN DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 10180 WASHINGTON AVE
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City | MOUNT PLEASANT
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State | WI
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Zip | 53177-1604
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Country | US
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Telephone | 262-687-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 S KINNICKINNIC AVE APT 413
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City | MILWAUKEE
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State | WI
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Zip | 53207-1324
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Country | US
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Telephone | 920-918-9543
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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