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General NPI Number Information
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NPI Number | 1053552703
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Entity Type | Individual
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Provider Name | JAYNE LYNN FOX PT
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Gender | Female
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/10/2009
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Provider Practice Location Address
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Address Line | 304 KAPHAEM RD
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City | TOMAHAWK
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State | WI
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Zip | 54487-7800
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Country | US
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Telephone | 715-453-2141
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Fax | 715-459-7519
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Provider Business Mailing Address
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Address Line | 912 N MEMORIAL DR PO BOX 710
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City | MERRILL
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State | WI
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Zip | 54452-3164
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Country | US
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Telephone | 715-539-2510
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Fax | 715-536-6146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1052-024
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License Number State | WI
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