Grace-Jensen, Michelle M

Grace-Jensen, Michelle M is an individual health care provider with primary practice located at 233 Carroll St , Random Lake WI 53075-1795. 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. Grace-Jensen, Michelle M can be contacted via phone (920) 912-0058.

Contact Information

Primary practice address
233 Carroll St Random Lake WI 53075-1795
Phone: (920) 912-0058
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 3728-24 Wisconsin

Profile Details

NPI number 1780625764
LBN Legal business name Grace-Jensen, Michelle M
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2006
Last updated Aug 13th, 2007 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780625764 NPPES
Wisconsin MEDICAID 36117700

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