Healthcare Provider Details

I. General information

NPI: 1215367032
Provider Name (Legal Business Name): JOCELYN STANISZEWSKI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 JEFFERSON ST
BARABOO WI
53913-1503
US

IV. Provider business mailing address

90 FIELDSTONE DR. APT 1209
WISCONSIN DELLS WI
53965
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-8532
  • Fax:
Mailing address:
  • Phone: 608-356-8532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2110-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: