Provider Demographics
NPI:1497778278
Name:EDELMANN, JESSICA A (MPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:EDELMANN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:SCHULTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 N PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2009
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:106 2ND AVE W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1634
Practice Address - Country:US
Practice Address - Phone:715-685-9656
Practice Address - Fax:715-685-9544
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10413-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00281530OtherRAILROAD MEDICARE
WI40452300Medicaid
WI111200OtherSECURITY HEALTH PLAN
WI484R6EDOtherGROUP HEALTH/BCBS OF MN