Healthcare Provider Details

I. General information

NPI: 1699606566
Provider Name (Legal Business Name): JACOB MONFILS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E GREEN BAY ST STE A
SHAWANO WI
54166-2472
US

IV. Provider business mailing address

2105 E ENTERPRISE AVE STE 113
APPLETON WI
54913-7862
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-5221
  • Fax: 715-526-2542
Mailing address:
  • Phone: 920-991-2561
  • Fax: 920-991-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17738-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: