Basic Information
| Provider Information | |||||||||
| NPI: | 1659922656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEND | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2248 BRANSON RD | ||||||||
| Address2: | |||||||||
| City: | FITCHBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535751902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083342941 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1619 N STOUGHTON RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537042603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082441213 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2019 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 14792-24 | WI | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.