Provider Demographics
NPI:1962675314
Name:DOBEK, JACK (CMT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:DOBEK
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:F
Other - Last Name:DOBEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:54 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1426
Mailing Address - Country:US
Mailing Address - Phone:802-388-0414
Mailing Address - Fax:
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1426
Practice Address - Country:US
Practice Address - Phone:802-388-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist