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General NPI Number Information
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NPI Number | 1427224047
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Entity Type | Individual
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Provider Name | JEAN SOPHIE DELFORGE PT
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Gender | Female
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Dates
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Enumeration Date | 05/04/2008
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Last Update Date | 05/04/2008
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Provider Practice Location Address
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Address Line | 400 MICHIGAN AVE
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City | OCONTO
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State | WI
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Zip | 54153-1764
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Country | US
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Telephone | 920-834-7808
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 N RIVER RD
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City | OCONTO
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State | WI
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Zip | 54153-9435
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Country | US
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Telephone | 920-834-5893
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Fax | 920-834-5893
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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 | 1258-024
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1258-024
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License Number State | WI
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