Boldon, Dawnine Marie

Boldon, Dawnine Marie is an individual health care provider with primary practice located at 200 E Tyranena Park Rd , Lake Mills WI 53551-9678. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Boldon, Dawnine Marie can be contacted via phone (920) 648-8170.

Contact Information

Primary practice address
200 E Tyranena Park Rd Lake Mills WI 53551-9678
Phone: (920) 648-8170
Fax: (920) 648-8225
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 966-019 Wisconsin

Profile Details

NPI number 1851569628
LBN Legal business name Boldon, Dawnine Marie
Credentials LPTA
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2008
Last updated Feb 14th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851569628 NPPES
Wisconsin MEDICAID 36149300

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