Individual
JILL MELISSA PAQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6051-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40403300
—
WI
Enumeration date
04/08/2008
Last updated
10/25/2016
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