Individual
MRS. EMILY ERIN DENNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T
Contact information
Practice address
1626 N SPRING ST, SUITE B, BEAVER DAM, WI 53916-1283
(920) 356-0122
(920) 356-0470
Mailing address
PO BOX 775, BEAVER DAM, WI 53916-0775
(920) 356-0122
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12754
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922363555
—
WI
01
—
WI3182
MEDICARE PTAN
WI
Enumeration date
11/11/2015
Last updated
11/11/2015
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