Provider Demographics
NPI:1699313072
Name:DARTT, GAIL SUZANNE (LMT)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:SUZANNE
Last Name:DARTT
Suffix:
Gender:F
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:N2692 COUNTY HIGHWAY V #A
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555
Mailing Address - Country:US
Mailing Address - Phone:920-210-4472
Mailing Address - Fax:
Practice Address - Street 1:513 N US HIGHWAY 51 # A
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955-9335
Practice Address - Country:US
Practice Address - Phone:608-635-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13678-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist