Provider Demographics
NPI:1407973290
Name:MEDINA, FRANCIS JASON DIZON (PT)
Entity Type:Individual
Prefix:
First Name:FRANCIS JASON
Middle Name:DIZON
Last Name:MEDINA
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 1:311 W KALSCHED ST
Mailing Address - Street 2:APT 115
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1466
Mailing Address - Country:US
Mailing Address - Phone:310-526-1704
Mailing Address - Fax:
Practice Address - Street 1:702 W DOLF ST
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:WI
Practice Address - Zip Code:54421-9604
Practice Address - Country:US
Practice Address - Phone:715-223-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10722024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist