Provider Demographics
NPI:1275591174
Name:HOME, DENNIS (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:HOME
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2246
Mailing Address - Country:US
Mailing Address - Phone:608-299-8181
Mailing Address - Fax:608-299-8181
Practice Address - Street 1:2737 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2246
Practice Address - Country:US
Practice Address - Phone:608-299-8181
Practice Address - Fax:608-299-8281
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2282-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40038600Medicaid
WI40038600Medicaid
WIP06911Medicare UPIN