Provider Demographics
NPI:1164952016
Name:GREISINGER, JAMIE L (DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:GREISINGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:BERGELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1532 S GREEN BAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4468
Mailing Address - Country:US
Mailing Address - Phone:262-321-0240
Mailing Address - Fax:262-321-0242
Practice Address - Street 1:700 PILGRIM PKWY STE L8
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2064
Practice Address - Country:US
Practice Address - Phone:262-796-2850
Practice Address - Fax:262-796-2851
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13770-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist