Healthcare Provider Details

I. General information

NPI: 1053880419
Provider Name (Legal Business Name): JESSICA LYNN MEEUSEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CHEYENNE CT
GRAFTON WI
53024-9368
US

IV. Provider business mailing address

2020 CHEYENNE CT
GRAFTON WI
53024-9368
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-1075
  • Fax: 262-375-4975
Mailing address:
  • Phone: 262-375-1075
  • Fax: 262-375-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14384-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: