Individual
JENNIFER J WALLSKOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1414 S PARK ST, MADISON, WI 53715-2106
(608) 417-8250
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3333
WI
2251X0800X
Orthopedic Physical Therapist
3333
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36113600
—
WI
Enumeration date
11/30/2006
Last updated
01/02/2015
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