Provider Demographics
NPI:1700364429
Name:JANSSEN, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 TOWN HALL DR
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:WI
Mailing Address - Zip Code:54162-8920
Mailing Address - Country:US
Mailing Address - Phone:920-680-5026
Mailing Address - Fax:
Practice Address - Street 1:1511 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4801
Practice Address - Country:US
Practice Address - Phone:920-720-0660
Practice Address - Fax:920-720-0666
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist