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NPI Code Detail

MEDICARE: MADELINE CLAIRE JERRY

MEDICARE: MADELINE CLAIRE JERRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist17838-24WI

General Provider Information

NPI Number : 1013573633
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE CLAIRE JERRY
Provider Business Mailing Address
First Line : 1550 15TH CT
Second Line :
City : KENOSHA
State : WI
Zip : 53140-1508
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12500 AURORA DR
Second Line :
City : PLEASANT PRAIRIE
State : WI
Zip : 53158-1227
Country : US
Telephone Number : 262-857-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2019
Last Update Date : 06/18/2026

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Directions to “ MADELINE CLAIRE JERRY ” Practice Location

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