Provider Demographics
NPI:1497905301
Name:DEWICK, JON PAUL (DPT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:PAUL
Last Name:DEWICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2430B
Mailing Address - Street 2:
Mailing Address - City:BIRCH TREE
Mailing Address - State:MO
Mailing Address - Zip Code:65438-9222
Mailing Address - Country:US
Mailing Address - Phone:573-292-1222
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 2430B
Practice Address - Street 2:
Practice Address - City:BIRCH TREE
Practice Address - State:MO
Practice Address - Zip Code:65438-9222
Practice Address - Country:US
Practice Address - Phone:573-292-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008011475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist