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NPI Code Detail

MEDICARE: JERAD J ARENDT PT

MEDICARE: JERAD J ARENDT PT
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 Therapist11493-24WI

General Provider Information

NPI Number : 1366753972
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERAD J ARENDT PT
Provider Business Mailing Address
First Line : PO BOX 22487
Second Line :
City : GREEN BAY
State : WI
Zip : 54305-2487
Country : US
Telephone Number : 920-445-7222
Fax Number : 920-445-7289
Provider Business Practice Location Address
First Line : 1630 COMMANCHE AVE
Second Line : BELLIN SPORTS MEDICINE WEST
City : GREEN BAY
State : WI
Zip : 54313-5753
Country : US
Telephone Number : 920-430-4750
Fax Number : 920-430-4746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2010
Last Update Date : 01/14/2020

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