Individual
MS. JESSICA MARIE THEROUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, CSCS
Contact information
Practice address
2105 E ENTERPRISE AVE, SUITE 113, APPLETON, WI 54913-7862
(920) 991-2561
(920) 991-2563
Mailing address
1605 SWAN RD, APT 1, DE PERE, WI 54115-8499
(920) 265-0443
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
465-039
WI
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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