Provider Demographics
NPI:1740628411
Name:DAHMEN, CORY JAMES
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:JAMES
Last Name:DAHMEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-2940
Mailing Address - Country:US
Mailing Address - Phone:608-214-7667
Mailing Address - Fax:
Practice Address - Street 1:1816 14TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-2940
Practice Address - Country:US
Practice Address - Phone:608-214-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant