Basic Information
| Provider Information | |||||||||
| NPI: | 1255424081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLESTINSKI | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | USELMAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7335 ARCTIC FOX DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537196223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088487057 | ||||||||
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| Practice Location | |||||||||
| Address1: | 411 PRAIRIE HEIGHTS DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | VERONA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535932238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088486628 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Q08782 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 40430400 | 05 | WI | MEDICAID |