Individual
JACLYN L DODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
200 S 9TH ST, DE PERE, WI 54115-1393
(920) 336-5680
Mailing address
204 S HELEN ST, KIMBERLY, WI 54136-1727
(920) 819-5503
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1362
WI
225200000X
Physical Therapy Assistant
Primary
1362-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427225721
—
WI
05
—
36139300
—
WI
Enumeration date
05/15/2008
Last updated
03/14/2019
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