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General NPI Number Information
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NPI Number | 1336777531
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Entity Type | Individual
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Provider Name | JENNIFER MARIE KOLESAR-SPRINGHETTI DPT
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 725 AMERICAN AVE
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City | WAUKESHA
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State | WI
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Zip | 53188-5031
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Country | US
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Telephone | 262-928-2445
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Fax |
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Provider Business Mailing Address
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Address Line | 1241 SARATOGA PKWY
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4431
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Country | US
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Telephone | 262-560-0408
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Fax |
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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 | 5634-24
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License Number State | WI
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