Provider Demographics
NPI:1184282485
Name:MARLENGA, DAYNE JOHN (PTA)
Entity type:Individual
Prefix:
First Name:DAYNE
Middle Name:JOHN
Last Name:MARLENGA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9347 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:WI
Mailing Address - Zip Code:54515-9741
Mailing Address - Country:US
Mailing Address - Phone:715-820-1225
Mailing Address - Fax:
Practice Address - Street 1:1700 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1230
Practice Address - Country:US
Practice Address - Phone:920-739-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2919-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant