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JACOB J BLIEFERNICHT PT

>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1962521328

Individual Registrant:
 JACOB J BLIEFERNICHT PT
Gender: M
Not Sole Proprietor

Location and contact information for practice:
4861 S 27TH ST  GREENFIELD, WI 53221-2603 US
Tel: 414-325-3325  Fax: --

Contact information for business:
790 REMINGTON BLVD  BOLINGBROOK, IL 60440-4909 US
Tel: 630-296-2223  Fax: --

Registration Information:
NPI: 1962521328
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
WI11392-24
N225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
IL070015662

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
MEDICAID1962521328WI01




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