Provider Demographics
NPI:1659440923
Name:FAMEREE, DANA (PHYSICAL THERAPY AST)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:FAMEREE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY AST
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPY AST
Mailing Address - Street 1:3100 SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-5111
Mailing Address - Fax:715-732-0628
Practice Address - Street 1:3117 SHORE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MARINNETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-5111
Practice Address - Fax:715-732-0628
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47219225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4039000Medicaid
WI4039000Medicaid