Individual
JULIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
516 26TH AVE, MONROE, WI 53566-1531
(608) 325-9141
Mailing address
N1399 DILL RD, BROWNTOWN, WI 53522-9760
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
821-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40469700
—
WI
Enumeration date
05/09/2007
Last updated
07/08/2007
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