Provider Demographics
NPI:1356518062
Name:WURM, JILL M (PTA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:WURM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2267
Mailing Address - Country:US
Mailing Address - Phone:608-787-0401
Mailing Address - Fax:
Practice Address - Street 1:323 BLACK RIVER AVE
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667-1127
Practice Address - Country:US
Practice Address - Phone:608-634-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI737-019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist