Provider Demographics
NPI:1275782732
Name:FRENCH-GRAEBNER, JILL LYNNETTE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LYNNETTE
Last Name:FRENCH-GRAEBNER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-3035
Mailing Address - Country:US
Mailing Address - Phone:651-308-7604
Mailing Address - Fax:
Practice Address - Street 1:3618 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-3035
Practice Address - Country:US
Practice Address - Phone:651-308-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3061 - 024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40262400Medicaid