Provider Demographics
NPI:1821255837
Name:BURMESCH, JARED MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:MICHAEL
Last Name:BURMESCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W BROWN DEER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2400
Mailing Address - Country:US
Mailing Address - Phone:414-357-7072
Mailing Address - Fax:414-355-2767
Practice Address - Street 1:4301 W BROWN DEER RD STE 101
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2400
Practice Address - Country:US
Practice Address - Phone:414-357-7072
Practice Address - Fax:414-355-2767
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9555-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist