Provider Demographics
NPI:1275887879
Name:BERCE, JENELLE (DPT)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:BERCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENELLE
Other - Middle Name:
Other - Last Name:BEHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:8700 DURAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-2096
Practice Address - Country:US
Practice Address - Phone:262-898-2480
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2012-11-04
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12191-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2382005Medicare PIN
P01275364Medicare PIN