Individual
JESSICA LYNN BLIEVERNICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1510 UNDERWOOD AVE, WAUWATOSA, WI 53213-2619
(262) 375-1075
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6335
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500649765
—
WA
Enumeration date
06/19/2012
Last updated
06/28/2024
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