Provider Demographics
NPI:1083876684
Name:SONDROL, DEAN JEROME
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:JEROME
Last Name:SONDROL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 E ENTERPRISE AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7862
Mailing Address - Country:US
Mailing Address - Phone:715-942-2553
Mailing Address - Fax:715-942-2554
Practice Address - Street 1:102 GRAND SEASONS DR STE 1
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-8298
Practice Address - Country:US
Practice Address - Phone:715-942-2553
Practice Address - Fax:715-258-1153
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist