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NPI Code Detail

MEDICARE: JENNIFER M WITCZAK P.T.

MEDICARE:   JENNIFER M WITCZAK  P.T.
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 Therapist5910-024WI

General Provider Information

NPI Number : 1487867412
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER M WITCZAK P.T.
Provider Business Mailing Address
First Line : 3602 S LOGAN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207
Country : US
Telephone Number : 414-517-0893
Fax Number :
Provider Business Practice Location Address
First Line : 1301 W CANAL ST STE 200
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-2667
Country : US
Telephone Number : 844-708-4819
Fax Number : 414-645-8811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 11/19/2018

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Directions to “ JENNIFER M WITCZAK P.T.” Practice Location

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