Provider Demographics
NPI:1265717490
Name:HEAD TO TOE PHYSICAL THERAPY
Entity type:Organization
Organization Name:HEAD TO TOE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
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 AVENUE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406
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:2011-10-19
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1330-24261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy