Provider Demographics
NPI:1437327111
Name:LEWEN, DAWN E (PTA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:E
Last Name:LEWEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:E
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:323 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1401
Mailing Address - Country:US
Mailing Address - Phone:920-743-5566
Mailing Address - Fax:
Practice Address - Street 1:10560 APPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SISTER BAY
Practice Address - State:WI
Practice Address - Zip Code:54234-9005
Practice Address - Country:US
Practice Address - Phone:920-854-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1450-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1450-019OtherLICENSE NUMBER
WI41229200Medicaid
WI521358Medicare Oscar/Certification