Provider Demographics
NPI:1639472756
Name:JOHN T. DEMBOWIAK, LPT, S.C.
Entity Type:Organization
Organization Name:JOHN T. DEMBOWIAK, LPT, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEMBOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:262-886-9887
Mailing Address - Street 1:PO BOX 1664
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53401-1664
Mailing Address - Country:US
Mailing Address - Phone:262-886-9887
Mailing Address - Fax:
Practice Address - Street 1:5820 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4020
Practice Address - Country:US
Practice Address - Phone:262-886-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1330-24261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40131200Medicaid
WI40131200Medicaid