Provider Demographics
NPI:1447316997
Name:PRUETTING, JILLIANN NELESSEN (PT)
Entity type:Individual
Prefix:MRS
First Name:JILLIANN
Middle Name:NELESSEN
Last Name:PRUETTING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILLIANN
Other - Middle Name:MARIE
Other - Last Name:NELESSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2414 SPRINGDALE RD
Mailing Address - Street 2:# 103
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2779
Mailing Address - Country:US
Mailing Address - Phone:920-427-1354
Mailing Address - Fax:
Practice Address - Street 1:2025 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-298-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10556-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist