Healthcare Provider Details

I. General information

NPI: 1457562696
Provider Name (Legal Business Name): JAYNE ZIEHM MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAYNE ZIEHM SINGLETON MPT

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 W LLOYD ST
WAUWATOSA WI
53213-2007
US

IV. Provider business mailing address

6317 W LLOYD ST
WAUWATOSA WI
53213-2007
US

V. Phone/Fax

Practice location:
  • Phone: 414-460-3831
  • Fax:
Mailing address:
  • Phone: 414-460-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5717
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5717
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: