Provider Demographics
NPI:1568273696
Name:PATOKA, BRANDON JACOB (DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JACOB
Last Name:PATOKA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 S VIEW DR STE 15132
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-8205
Mailing Address - Country:US
Mailing Address - Phone:715-398-2104
Mailing Address - Fax:715-322-2084
Practice Address - Street 1:880 S VIEW DR STE 15132
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-8205
Practice Address - Country:US
Practice Address - Phone:715-398-2104
Practice Address - Fax:715-322-2084
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17043-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist