Basic Information
| Provider Information | |||||||||
| NPI: | 1265618441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MESSIMER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | ELLIS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1806 W BELTLINE HWY | ||||||||
| Address2: | DEAN THERAPY CENTER | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082501485 | ||||||||
| FaxNumber: | 6082501456 | ||||||||
| Practice Location | |||||||||
| Address1: | 1806 W BELTLINE HWY | ||||||||
| Address2: | DEAN THERAPY CENTER | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082501485 | ||||||||
| FaxNumber: | 6082501456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2008 | ||||||||
| LastUpdateDate: | 11/09/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9584-024 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 60226 | 01 | WI | DEAN HEALTH INSURANCE | OTHER |