Individual
MS. JEANETTE M KNILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
720 S VANBUREN ST, GREEN BAY, WI 54230-3504
(920) 468-3444
(920) 432-6313
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12077--24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
767190
MEDICARE GROUP ID #
IL
Enumeration date
03/20/2007
Last updated
07/24/2020
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