Provider Demographics
NPI:1538485255
Name:JANIAK, DAWN CHRISTINE (PTA)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:CHRISTINE
Last Name:JANIAK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8084 SOUKUP RD
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:WI
Mailing Address - Zip Code:54112-9639
Mailing Address - Country:US
Mailing Address - Phone:920-897-5000
Mailing Address - Fax:
Practice Address - Street 1:430 MANOR DR
Practice Address - Street 2:
Practice Address - City:SURING
Practice Address - State:WI
Practice Address - Zip Code:54174-9182
Practice Address - Country:US
Practice Address - Phone:920-842-2191
Practice Address - Fax:920-842-2176
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1528-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant