Individual
JACOB J BLIEFERNICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4861 S 27TH ST, GREENFIELD, WI 53221-2603
(414) 325-3325
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070015662
IL
225100000X
Physical Therapist
Primary
11392-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962521328
MEDICAID
WI
Enumeration date
03/28/2007
Last updated
07/07/2010
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