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NPI Code Detail

MEDICARE: JENNELLE HASKINS

MEDICARE: JENNELLE HASKINS
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 Therapist14522-24WI

General Provider Information

NPI Number : 1487111324
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNELLE HASKINS
Provider Business Mailing Address
First Line : 106 S HOLMEN DR STE 2
Second Line :
City : HOLMEN
State : WI
Zip : 54636-9468
Country : US
Telephone Number : 608-526-9888
Fax Number :
Provider Business Practice Location Address
First Line : 106 S HOLMEN DR STE 2
Second Line :
City : HOLMEN
State : WI
Zip : 54636-9468
Country : US
Telephone Number : 608-526-9888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2019
Last Update Date : 09/19/2019

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