Individual
JORDYNN LEE WALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
200 E RYAN RD, OAK CREEK, WI 53154-4563
(414) 570-7600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16757
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100281549
—
WI
Enumeration date
05/10/2024
Last updated
08/15/2024
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