Individual
MR. GREGORY WILLIAM JOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
8320 W BLUEMOUND RD, WAUWATOSA, WI 53213-3367
(414) 302-3800
Mailing address
5653 N STANTON DR, GLENDALE, WI 53209-4357
(414) 238-3229
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
821-146
WI
Other
Enumeration date
03/15/2013
Last updated
03/15/2013
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