Individual
JENNIFER L. BALLWEG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2300 US HWY 51 138, SUITE G, STOUGHTON, WI 53589-0000
(608) 873-2292
Mailing address
900 RIDGE ST, STOUGHTON, WI 53589-1864
(608) 873-2292
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11544-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11544-024
—
WI
Enumeration date
09/22/2010
Last updated
09/22/2010
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