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Individual

MRS. JACQUELINE MARIE OVERPECK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT, DPT

Contact information

Practice address
2420 WILSON AVE, MADISON, IN 47250-2135
(812) 265-8226
(812) 265-8227
Mailing address
1928 FAIRWAY DR, MADISON, IN 47250-2703
(812) 274-4040

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05008585A
IN
2251P0200X
Pediatric Physical Therapist
Primary
05008585A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200857980
IN
05
7100168390
KY
Enumeration date
04/10/2007
Last updated
09/13/2017
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