Individual
JENNIFER LYNN BALTHAZOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
2919 SHELTER CREEK CT, GREEN BAY, WI 54313-4549
(920) 429-0921
Mailing address
2919 SHELTER CREEK CT, GREEN BAY, WI 54313-4549
(920) 429-0921
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4842-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40313400
—
WI
Enumeration date
05/04/2008
Last updated
05/04/2008
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