Provider Demographics
NPI:1497736359
Name:MONTET, DENNIS CLARENCE (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:CLARENCE
Last Name:MONTET
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:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-0499
Mailing Address - Country:US
Mailing Address - Phone:563-568-2176
Mailing Address - Fax:563-568-2184
Practice Address - Street 1:1650 ALLAMAKEE ST NW
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-7825
Practice Address - Country:US
Practice Address - Phone:563-568-2176
Practice Address - Fax:563-568-2184
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA278225100000X
WI3002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0180299Medicaid
IA28976OtherWELLMARK
IA0180299Medicaid