Provider Demographics
NPI:1699960062
Name:POKORNY, JENNIFER CAROLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CAROLE
Last Name:POKORNY
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 1:5111 PLATEAU CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-3375
Mailing Address - Country:US
Mailing Address - Phone:262-514-2631
Mailing Address - Fax:
Practice Address - Street 1:316 NORTH MILWAUKEE STREET
Practice Address - Street 2:SUITE 208, HERITAGE HEALTHGROUP
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5803
Practice Address - Country:US
Practice Address - Phone:888-389-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI316-019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist