Individual
KERRY JACQUET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
5219 88TH AVE, KENOSHA, WI 53144-7468
(262) 653-0850
(262) 653-0853
Mailing address
5219 88TH AVE, KENOSHA, WI 53144-7468
(262) 653-0850
(262) 653-0853
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
13622
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073060521
—
WI
Enumeration date
09/01/2016
Last updated
03/24/2017
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