Provider Demographics
NPI:1356442834
Name:DIXEN-DADEZ, WENDY J (PT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:DIXEN-DADEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 S ARCH AVE
Mailing Address - Street 2:DADEZ PHYSICAL THERAPY, INC
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1832
Mailing Address - Country:US
Mailing Address - Phone:715-246-3809
Mailing Address - Fax:715-246-7139
Practice Address - Street 1:471 S ARCH AVE
Practice Address - Street 2:DADEZ PHYSICAL THERAPY, INC
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1832
Practice Address - Country:US
Practice Address - Phone:715-246-3809
Practice Address - Fax:715-246-7139
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3795225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN43G23DAOtherBLUE CROSS BLUE SHIELD
WI41810700Medicaid
MN6401770OtherMEDICA
MNHP46028OtherHEALTH PARTNERS
MN43G23DAOtherBLUE CROSS BLUE SHIELD