Provider Demographics
NPI:1053552703
Name:FOX, JAYNE LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:LYNN
Last Name:FOX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JAYNE
Other - Middle Name:LYNN
Other - Last Name:KERKHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:912 N MEMORIAL DR
Mailing Address - Street 2:PO BOX 710
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-3164
Mailing Address - Country:US
Mailing Address - Phone:715-539-2510
Mailing Address - Fax:715-536-6146
Practice Address - Street 1:304 KAPHAEM RD
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-7800
Practice Address - Country:US
Practice Address - Phone:715-453-2141
Practice Address - Fax:715-459-7519
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1052-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist