Provider Demographics
NPI:1740905413
Name:DOCKHAM, JOURNEY J
Entity type:Individual
Prefix:
First Name:JOURNEY
Middle Name:J
Last Name:DOCKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOURNEY
Other - Middle Name:J
Other - Last Name:GONTJES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 E ENTERPRISE AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7401
Mailing Address - Country:US
Mailing Address - Phone:920-738-0671
Mailing Address - Fax:920-738-0773
Practice Address - Street 1:2901 E ENTERPRISE AVE STE 600
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7401
Practice Address - Country:US
Practice Address - Phone:920-738-0671
Practice Address - Fax:920-738-0773
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12805225100000X
WI16091-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist