Healthcare Provider Details

I. General information

NPI: 1306776448
Provider Name (Legal Business Name): JESSICA PLOOF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N496 MILKY WAY
APPLETON WI
54915-3993
US

IV. Provider business mailing address

2067 BRIDGE PORT CT APT 8
DE PERE WI
54115-8043
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-2681
  • Fax:
Mailing address:
  • Phone: 920-680-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: