Wiersma, Jacqueline
Wiersma, Jacqueline is an sole proprietor health care provider with primary practice located at 1930 E Southern Ave , Tempe AZ 85282-7518. 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. Wiersma, Jacqueline can be contacted via phone (480) 456-0719.Contact Information
Primary practice address
1930 E Southern Ave
Tempe AZ 85282-7518
Phone: (480) 456-0719
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 7437 | Arizona |
Profile Details
| NPI number | 1154517274 |
|---|---|
| LBN Legal business name | Wiersma, Jacqueline |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 21st, 2007 |
| Last updated | Sep 15th, 2009 - about 15 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 | 1154517274 | NPPES |
| Arizona | MEDICAID | 260138 |
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