Healthcare Provider Details

I. General information

NPI: 1326967993
Provider Name (Legal Business Name): JESSICA BRASKAMP DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 W 9TH ST
FOND DU LAC WI
54935-4956
US

IV. Provider business mailing address

123 S STATE ST
WAUPUN WI
53963-1958
US

V. Phone/Fax

Practice location:
  • Phone: 920-906-6520
  • Fax:
Mailing address:
  • Phone: 920-763-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15524-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: