Individual
JODY LYNN STREETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
W8645 HANNA LN, OAKFIELD, WI 53065-9546
(920) 579-5168
(920) 479-2991
Mailing address
PO BOX 1095, FOND DU LAC, WI 54936-1095
(920) 579-5168
(920) 479-2991
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9784-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40393700
—
WI
Enumeration date
03/23/2007
Last updated
07/12/2022
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