Provider Demographics
NPI:1083930341
Name:FATER, DENNIS CARROLL WILKINS (PHD, PT, CERT MDT)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CARROLL WILKINS
Last Name:FATER
Suffix:
Gender:M
Credentials:PHD, PT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5076
Mailing Address - Country:US
Mailing Address - Phone:608-782-5954
Mailing Address - Fax:
Practice Address - Street 1:1927 MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5076
Practice Address - Country:US
Practice Address - Phone:608-782-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4189-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist