Individual
JONATHAN DERVETSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1030 OAK RIDGE DR, EAU CLAIRE, WI 54701-4564
(715) 456-6755
Mailing address
1922 WOODLAND AVE, EAU CLAIRE, WI 54701-4165
(715) 828-1008
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12319-146
WI
Other
Enumeration date
05/16/2014
Last updated
05/16/2014
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