Demotris Dwayne De Valk Jr.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

16408 Issued in WI

Practice address

13250 Washington Ave
Mount Pleasant, WI 53177-1516

Phone

(262) 799-8330

NPI assigned

Jun 4, 2019

Reactivated

Oct 25, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1235797341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13250 WASHINGTON AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "531771516",
            "telephone_number": "262-799-8330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE VALK",
        "first_name": "DEMOTRIS",
        "middle_name": "DWAYNE",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-04",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "deactivation_date": "2019-06-04",
        "reactivation_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "16408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "80840",
            "identifier": "911-39026-02",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Lynn Davies, MA/CCC-SLP
• James F Davis, RPH
• Lanette Lynn Davis, PMHNP
• Sabrina Marie Davis, RBT
• Nashali De Leon Hernandez
• De Witt Physical Therapy & Wellness LLC
• Dean Pain Management SC
• Sheryl Ann Dean, LCSW,BSW,CSAC,RCS
• Heather Kay Debruin, OTR MS
• Deerwood Orthodontics, LLC

• Physical Therapist in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.