Provider Demographics
NPI:1740905413
Name:DOCKHAM, JOURNEY J (PT)
Entity type:Individual
Prefix:
First Name:JOURNEY
Middle Name:J
Last Name:DOCKHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOURNEY
Other - Middle Name:J
Other - Last Name:GONTJES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:
Practice Address - Street 1:4316 RICE LAKE RD STE 107
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2885
Practice Address - Country:US
Practice Address - Phone:218-727-1180
Practice Address - Fax:844-856-3737
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16091-24225100000X
MN12805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist