Provider Demographics
NPI:1063649622
Name:DEMARIS, JOEL C (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:C
Last Name:DEMARIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 136
Mailing Address - Street 2:139 MAIN STREET
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005
Mailing Address - Country:US
Mailing Address - Phone:763-444-8680
Mailing Address - Fax:763-444-5544
Practice Address - Street 1:2 ENTERPRISE AVENUE, SUITE E4
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040
Practice Address - Country:US
Practice Address - Phone:763-444-8680
Practice Address - Fax:763-444-5544
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8864225100000X
NE2781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist