Provider Demographics
NPI:1396556627
Name:KEMEZY, DANE
Entity type:Individual
Prefix:
First Name:DANE
Middle Name:
Last Name:KEMEZY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 W LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8962
Mailing Address - Country:US
Mailing Address - Phone:217-836-7707
Mailing Address - Fax:
Practice Address - Street 1:520 N 32ND AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4701
Practice Address - Country:US
Practice Address - Phone:715-847-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICP038748T225100000X
MO2022043937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist