Individual
MISS DEANNA MARIE DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3821 S CHICAGO AVE, SOUTH MILWAUKEE, WI 53172-3712
(414) 762-7336
Mailing address
8550 S PARKNOLL DR, OAK CREEK, WI 53154-3436
(262) 914-3764
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
522019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36106700
—
WI
Enumeration date
05/09/2007
Last updated
03/07/2017
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