1356442834 NPI number — WENDY J DIXEN-DADEZ PT

Table of content: WENDY J DIXEN-DADEZ PT (NPI 1356442834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356442834 NPI number — WENDY J DIXEN-DADEZ PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXEN-DADEZ
Provider First Name:
WENDY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356442834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
471 S ARCH AVE
Provider Second Line Business Mailing Address:
DADEZ PHYSICAL THERAPY, INC
Provider Business Mailing Address City Name:
NEW RICHMOND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54017-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-246-3809
Provider Business Mailing Address Fax Number:
715-246-7139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
471 S ARCH AVE
Provider Second Line Business Practice Location Address:
DADEZ PHYSICAL THERAPY, INC
Provider Business Practice Location Address City Name:
NEW RICHMOND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54017-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-246-3809
Provider Business Practice Location Address Fax Number:
715-246-7139
Provider Enumeration Date:
09/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3795 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43G23DA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41810700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6401770 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP46028 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".