Doctor Name: | JONATHAN DERVETSKI |
NPI Number: | 1821409418 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 12319-146 |
Business Practice Address: | 1030 Oak Ridge Dr Eau Claire, WI - 547014564 |
Business Phone Number: | 7154566755 |
Business Fax Number: | |
Mailing Address: | 1922 Woodland Ave, EAU CLAIRE |
State: | WI |
Postal Code: | 547014165 |
Phone Number: | 7158281008 |
Fax Number: | |
NPI Enumeration Date: | 05/16/2014 |
NPI Last Update Date: | 05/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 12319-146 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |