Individual
MRS. JACKIE LESAGE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
2025 E NEWPORT AVE, MILWAUKEE, WI 53211-2906
(414) 963-8476
Mailing address
2567 N BARTLETT AVE, MILWAUKEE, WI 53211-3953
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5954-024
WI
Other
Enumeration date
06/03/2006
Last updated
07/08/2007
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