Provider Demographics
NPI:1083727903
Name:LEWANDOWSKI, PAGE
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N10604 CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:54177-9112
Mailing Address - Country:US
Mailing Address - Phone:715-856-5554
Mailing Address - Fax:
Practice Address - Street 1:2500 HALL AVE STE B
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1604
Practice Address - Country:US
Practice Address - Phone:715-732-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3739-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist