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General NPI Number Information
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NPI Number | 1497778278
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Entity Type | Individual
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Provider Name | JESSICA A. EDELMANN MPT
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 106 2ND AVE W
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City | ASHLAND
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State | WI
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Zip | 54806-1634
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Country | US
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Telephone | 715-685-9656
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Fax | 715-685-9544
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Provider Business Mailing Address
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Address Line | 4000 N PROVIDENCE AVE
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City | APPLETON
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State | WI
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Zip | 54913-8018
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Country | US
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Telephone | 920-257-2009
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Fax | 920-257-2004
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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 | 10413-024
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License Number State | WI
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