Healthcare Provider Details

I. General information

NPI: 1609829753
Provider Name (Legal Business Name): JODEE JAEGER PLAZEK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E NEWPORT AVE
MILWAUKEE WI
53211-2906
US

IV. Provider business mailing address

5859 S 42ND ST
GREENFIELD WI
53221-3927
US

V. Phone/Fax

Practice location:
  • Phone: 414-298-6720
  • Fax: 414-298-6790
Mailing address:
  • Phone: 414-423-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2331-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: