Provider Demographics
NPI:1952597486
Name:PETER JOHN JACQUES
Entity Type:Organization
Organization Name:PETER JOHN JACQUES
Other - Org Name:WALKING AND WHEELING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:920-540-8840
Mailing Address - Street 1:W4652 GLENN ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9563
Mailing Address - Country:US
Mailing Address - Phone:920-540-8840
Mailing Address - Fax:866-878-1996
Practice Address - Street 1:W4652 GLENN ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9563
Practice Address - Country:US
Practice Address - Phone:920-540-8840
Practice Address - Fax:866-878-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3448024225100000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41750700Medicaid