Provider Demographics
NPI:1912145376
Name:LEMKE, WILLIAM ERVIN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ERVIN
Last Name:LEMKE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 PONDEROSA CT
Mailing Address - Street 2:P.O. BOX1353
Mailing Address - City:DUBOIS
Mailing Address - State:WY
Mailing Address - Zip Code:82513-9603
Mailing Address - Country:US
Mailing Address - Phone:307-455-2236
Mailing Address - Fax:307-455-2236
Practice Address - Street 1:2 PONDEROSA CT
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:WY
Practice Address - Zip Code:82513-9603
Practice Address - Country:US
Practice Address - Phone:307-455-2236
Practice Address - Fax:307-455-2236
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-4038684OtherEIN