Provider Demographics
NPI:1427021807
Name:DAMASCHKE, JEFFREY ALLAN (DPT, MS, OCS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:DAMASCHKE
Suffix:
Gender:M
Credentials:DPT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 6TH ST
Mailing Address - Street 2:PHYSICAL THERAPY DEPARTMENT
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-2833
Mailing Address - Country:US
Mailing Address - Phone:847-688-2368
Mailing Address - Fax:
Practice Address - Street 1:3001 6TH ST
Practice Address - Street 2:PHYSICAL THERAPY DEPARTMENT
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:847-688-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider