Provider Demographics
NPI:1417027194
Name:MATHER, JEANNE HANDRICK (PT)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:HANDRICK
Last Name:MATHER
Suffix:
Gender:F
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:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-0827
Mailing Address - Country:US
Mailing Address - Phone:715-356-9729
Mailing Address - Fax:715-358-5209
Practice Address - Street 1:1106 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9729
Practice Address - Country:US
Practice Address - Phone:715-356-9729
Practice Address - Fax:715-358-5209
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1942-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40023500Medicaid
WI000083026OtherMEDICARE