Provider Demographics
NPI:1598854721
Name:ZACHOW, JOAN E (PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:ZACHOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 ATKINSON ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1439
Mailing Address - Country:US
Mailing Address - Phone:262-363-3268
Mailing Address - Fax:262-363-3269
Practice Address - Street 1:111 ATKINSON ST
Practice Address - Street 2:UNIT 2
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1439
Practice Address - Country:US
Practice Address - Phone:262-363-3268
Practice Address - Fax:262-363-3269
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40457800Medicaid
WI40457800Medicaid
WIP92707Medicare UPIN