Individual
JACQUELINE C SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
9000 W SURA LN, GREENFIELD, WI 53228-3477
(414) 246-6800
(414) 246-6405
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 246-6800
(414) 246-6405
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11733
WI
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962795021
—
WI
Enumeration date
05/24/2011
Last updated
12/05/2022
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