Individual
JEANNINE MARIE KNICKERBOCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1731 W RIDGEWAY AVE, WATERLOO, IA 50701-4594
(319) 833-5900
(319) 833-5901
Mailing address
PO BOX 2758, WATERLOO, IA 50704-2758
(319) 235-5390
(319) 287-9249
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03966
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0744060
—
IA
01
—
29208
WELLMARK
—
Enumeration date
12/06/2006
Last updated
12/07/2007
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