Individual
MR. JOSELITO JIMENEZ BONGCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3312 TERRACE CT, WAUSAU, WI 54401-4904
(636) 451-7090
Mailing address
3312 TERRACE CT, WAUSAU, WI 54401-4904
(636) 451-7090
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10462-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40476300
—
WI
Enumeration date
04/14/2007
Last updated
10/27/2012
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