Individual
MICHELLE M GRACE-JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
233 CARROLL ST, RANDOM LAKE, WI 53075-1795
(920) 912-0058
Mailing address
W8093 COUNTY A, ADELL, WI 53001-1462
(920) 994-2599
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3728-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36117700
—
WI
Enumeration date
06/09/2006
Last updated
08/13/2007
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