Healthcare Provider Details

I. General information

NPI: 1487198008
Provider Name (Legal Business Name): CHRISTINE TJERNAGEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N RIVERCENTER DR REHABILITATION/THERAPY DEPT
MILWAUKEE WI
53212-3978
US

IV. Provider business mailing address

1575 N RIVERCENTER DR REHABILITATION/THERAPY DEPT
MILWAUKEE WI
53212-3978
US

V. Phone/Fax

Practice location:
  • Phone: 414-224-6424
  • Fax:
Mailing address:
  • Phone: 414-224-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10262
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: