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)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