THOMAS DETTLAFF (NPI# 1912375411) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912375411 |
| Entity Type | Individual |
| Full Name | THOMAS DETTLAFF |
| Practice Address |
1886 Little Valley Ct De Pere WI 54115-7901 |
| Practice Telephone | 9206063489 |
| Mailing Telephone | 9206063489 |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
1886 LITTLE VALLEY CT |
| City | DE PERE |
| State | WI |
| Zip Code | 54115-7901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871138073 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 723 Main Ave, Depere, WI 54115 | 2019-11-12 |
| 1568928083 | Stephanie J Towle | Speech-Language Pathologist | 200 S. 9th St, De Pere, WI 54115 | 2019-02-20 |
| 1164988499 | Maribel L Zoeller | Physical Therapy Assistant | 200 S. 9th Street, Depere, WI 54115 | 2019-02-12 |
| 1255897641 | Elizabeth Eberius | Acupuncturist | 3311 S. Packerland Drive, Suite A #20, De Pere, WI 54115 | 2019-02-11 |
| 1548750458 | Jordyn E Arndt | Physical Therapist | 1601 Lawrence Dr Ste 100, De Pere, WI 54115 | 2018-05-16 |
| 1588153514 | David Nowakowski | Registered Nurse | 158 Cavil Way, De Pere, WI 54115 | 2018-05-04 |
| 1457858557 | Rennes Assisted Living Corp. | Assisted Living Facility | 1150 Lois Street, Depere, WI 54115 | 2018-04-06 |
| 1518473966 | Kirsten Lynne Masrelian | Behavioral Analyst | 2073 Lawrence Dr, De Pere, WI 54115 | 2017-12-21 |
| 1285146050 | Sydney Marie Schultz | Physical Medicine & Rehabilitation | 200 S. Ninth Street, De Pere, WI 54115 | 2017-11-01 |
| 1134666514 | Nicole L Bickham | Psychologist | 416 George St Ste 108, De Pere, WI 54115 | 2017-01-24 |
| Find all providers in zip 54115 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760047302 | Samantha Schumacher | Specialist/Technologist | W1633 County Road J, De Pere, WI 54115-8461 | 2019-05-09 |
| 1467962084 | Leah Watermolen | Specialist/Technologist | 702 N Huron St, De Pere, WI 54115-2621 | 2017-10-10 |
| 1275077059 | Ellen Lavin | Specialist/Technologist | 2058 Old Plank Ct, De Pere, WI 54115-8498 | 2016-12-13 |
| 1114395712 | Tyler John Van Sistine | Specialist/Technologist | 1598 Tiffany Ct, De Pere, WI 54115-9042 | 2015-09-13 |
| 1356729206 | Michael Snider | Specialist/Technologist | 1899 Little Valley Ct, De Pere, WI 54115-7901 | 2015-05-12 |
| 1821476805 | Austin Greenwood | Specialist/Technologist | 1154 Cardinal St, De Pere, WI 54115-4000 | 2015-05-11 |
| 1861889578 | Gregory Vincent Signorelli | Specialist/Technologist | 3357 Lost Dauphin Rd, De Pere, WI 54115-9446 | 2015-04-20 |
| 1093865495 | Brian Jp Mcwilliams | Specialist/Technologist | 1002 George St, De Pere, WI 54115-2952 | 2007-01-10 |
| 1437524659 | Heather Erfurt | Specialist/Technologist | 100 Grant St, De Pere, WI 54115-2002 | 2015-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427657329 | Tyler John Friis | Specialist/Technologist | 1514 E Keystone Ln, Appleton, WI 54913-7162 | 2020-10-21 |
| 1184222085 | Ryan James Mcnamara | Specialist/Technologist | 28914 Golden Cir, Waterford, WI 53185-1197 | 2020-10-13 |
| 1770198699 | Tanner Sterling | Specialist/Technologist | 2538 E Garrison Rd, Foxboro, WI 54836-9507 | 2020-09-09 |
| 1922626670 | Eric William Brostrom | Specialist/Technologist | 3305 Lilly Rd, Brookfield, WI 53005-7608 | 2020-07-09 |
| 1174146690 | Brycen Valiga | Specialist/Technologist | 4477 S 113th St, Greenfield, WI 53228-2566 | 2020-05-19 |
| 1104448307 | Xeing Randy Yang | Specialist/Technologist | 2207 Namekagon St, Hudson, WI 54016-9426 | 2020-05-11 |
| 1073134615 | Brian Wood | Specialist/Technologist | 1950 Washington St, Grafton, WI 53024-2103 | 2020-05-06 |
| 1124649751 | Cody Scott Tesch | Specialist/Technologist | 6680 N Teutonia Ave, Milwaukee, WI 53209-3117 | 2020-05-05 |
| 1659992642 | Kelley Potila | Specialist/Technologist | 255 Maggilu Ct, Jefferson, WI 53549-2095 | 2020-04-30 |
| 1366070708 | Claire Duwell | Specialist/Technologist | 9111 W Bluemound Rd, Milwaukee, WI 53226-4506 | 2020-03-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.