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General NPI Number Information
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NPI Number | 1669953329
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Entity Type | Individual
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Provider Name | DANIELLE LOREN JAEGER DPT
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Gender | Female
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 2195 N SUMMIT VILLAGE WAY
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City | OCONOMOWOC
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State | WI
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Zip | 53066-8675
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Country | US
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Telephone | 262-567-4662
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Fax |
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Provider Business Mailing Address
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Address Line | W148N7736 MENOMONEE MANOR DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-7324
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Country | US
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Telephone | 262-527-6446
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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 | 14047
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License Number State | WI
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