Jackie Church II

NPI #1104029362 in Edgerton, Wisconsin

Provider Information

NPI Number: 1104029362
Entity Type: Individual
Name: Jackie Church II
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Jun 6, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 313 STOUGHTON RD
City: Edgerton
State: Wisconsin
ZIP Code: 53534-1132
Phone: (608) 884-1390

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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