Provider Demographics
NPI:1811085210
Name:DEMBOWIAK, JOHN T (LPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:DEMBOWIAK
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4020
Practice Address - Country:US
Practice Address - Phone:262-886-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1330-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist