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General NPI Number Information
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NPI Number | 1902231384
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Entity Type | Individual
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Provider Name | MICHELLE JENS PTA
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Gender | Female
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | W175N11117 STONEWOOD DR SUITE 100
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City | GERMANTOWN
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State | WI
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Zip | 53022-6508
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Country | US
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Telephone | 262-293-3951
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Fax |
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Provider Business Mailing Address
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Address Line | N427 IRISH RD
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City | NEW HOLSTEIN
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State | WI
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Zip | 53061-9551
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Country | US
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Telephone | 920-286-1633
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 573-19
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License Number State | WI
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