Provider Demographics
NPI:1427289875
Name:REKEMEYER, DAVID WARREN (LMT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WARREN
Last Name:REKEMEYER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MAIN ST W
Mailing Address - Street 2:301
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1554
Mailing Address - Country:US
Mailing Address - Phone:715-682-3612
Mailing Address - Fax:
Practice Address - Street 1:502 MAIN ST W
Practice Address - Street 2:301
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1554
Practice Address - Country:US
Practice Address - Phone:715-682-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1046-049225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist