Provider Demographics
NPI:1598797581
Name:MONTEMURRO, JENNIFER ANN (PT, MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MONTEMURRO
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MPT
Mailing Address - Street 1:600 52ND ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3423
Mailing Address - Country:US
Mailing Address - Phone:262-925-5000
Mailing Address - Fax:262-925-5001
Practice Address - Street 1:9809 39TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-3733
Practice Address - Country:US
Practice Address - Phone:262-925-5080
Practice Address - Fax:262-925-5081
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012680225100000X
WI6076024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10759485OtherCAQH
WI40335300Medicaid
WI40335300Medicaid
ILL98904Medicare ID - Type Unspecified
ILL98905Medicare ID - Type Unspecified
WI0604410001OtherDMERC
WI001785940Medicare ID - Type Unspecified