Female

Jackie Church

Physical Therapy Assistant in Edgerton, WI(View on Map)

Full Name

Jackie Church

NPI Number

1104029362

NPI Type

Individual Provider

Gender

Female

Enumeration Date

06/06/2007

Specialties

(Taxonomies)

Code

225200000X

Primary Taxonomy

Yes

Licenses

State

Wisconsin

License Number

783-019

Contact
Information

Purpose

Mailing
Location

Address

313 STOUGHTON RD
313 STOUGHTON RD

City

Edgerton
Edgerton

State

WI
WI

Postal Code

53534-1132
53534-1132

Country

US
US

Telephone Number

(608) 884-1390
(608) 884-1390

Identifiers

Identifier

783-019

Identifier State

WI

Identifier Issuer

WISCONSIN LICENSE NUMBER

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/08/2007

Provider Address

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