Healthcare Provider Details

I. General information

NPI: 1447528724
Provider Name (Legal Business Name): JESSICA LYNN WURZEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 GARLAND ST E
WEST SALEM WI
54669-1308
US

IV. Provider business mailing address

2448 S 102ND ST SUITE 250
MILWAUKEE WI
53227-2466
US

V. Phone/Fax

Practice location:
  • Phone: 608-786-1400
  • Fax: 608-786-1419
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: