Wallace, Jill
Wallace, Jill is an individual health care provider with primary practice located at W239N1812 Rockwood Dr Ste 100 Phcma Inc., Waukesha WI 53188-1113. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Wallace, Jill can be contacted via phone (262) 523-0310.Contact Information
Primary practice address
W239N1812 Rockwood Dr Ste 100 Phcma Inc.
Waukesha WI 53188-1113
Phone: (262) 523-0310
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 10232 | Wisconsin |
Profile Details
| NPI number | 1104883099 |
|---|---|
| LBN Legal business name | Wallace, Jill |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 26th, 2006 |
| Last updated | Jan 18th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104883099 | NPPES |
| Wisconsin | MEDICAID | 40432300 |
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