Provider Demographics
NPI:1588814230
Name:MIKLE, JEAN T (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:T
Last Name:MIKLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 N STEVENS ST
Mailing Address - Street 2:P.O. BOX 716
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2161
Mailing Address - Country:US
Mailing Address - Phone:715-361-2230
Mailing Address - Fax:715-361-2239
Practice Address - Street 1:1864 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2161
Practice Address - Country:US
Practice Address - Phone:715-361-2230
Practice Address - Fax:715-361-2239
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3477-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40200700Medicaid