Individual
DEMOTRIS DWAYNE DE VALK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13250 WASHINGTON AVE, MOUNT PLEASANT, WI 53177-1516
(262) 799-8330
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16408
WI
225400000X
Rehabilitation Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
911-39026-02
80840
—
Enumeration date
06/04/2019
Last updated
11/02/2023
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