Basic Information
| Provider Information | |||||||||
| NPI: | 1447489216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEMBERGER | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 W 9TH AVE | ||||||||
| Address2: | STE 10 | ||||||||
| City: | OSHKOSH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549047247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202361850 | ||||||||
| FaxNumber: | 9202361860 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 W 9TH AVE | ||||||||
| Address2: | STE 10 | ||||||||
| City: | OSHKOSH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549047247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202361850 | ||||||||
| FaxNumber: | 9202361860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2009 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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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 | 11209-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1447489216 | 05 | WI | MEDICAID |