Provider Demographics
NPI:1679016778
Name:ALECKSON, AMY JO
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:ALECKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7192 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:ARENA
Mailing Address - State:WI
Mailing Address - Zip Code:53503-9104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7192 COUNTY ROAD H
Practice Address - Street 2:
Practice Address - City:ARENA
Practice Address - State:WI
Practice Address - Zip Code:53503-9104
Practice Address - Country:US
Practice Address - Phone:320-232-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist