=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700089760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE LISABETH LEMKE PHYSICAL THERAPIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19525 W NORTH AVE FRANCISCAN WOODS
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-785-1114
-----------------------------------------------------
Fax | 262-780-3805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | S32 W25019 GREEN VALLEY DRIVE
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-521-9794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5411024
-----------------------------------------------------
License Number State |
-----------------------------------------------------