Provider Demographics
NPI:1972824282
Name:GEMAR THELEN, DESSA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:DESSA
Middle Name:MARIE
Last Name:GEMAR THELEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DESSA
Other - Middle Name:MARIE
Other - Last Name:GEMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:714 BICKLEY CT
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1478
Mailing Address - Country:US
Mailing Address - Phone:608-334-4562
Mailing Address - Fax:
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11455-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist