Provider Demographics
NPI:1295935062
Name:THEISEN, JENNIFER MARIE (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:THEISEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KREMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13820 W PADDOCK PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2593
Mailing Address - Country:US
Mailing Address - Phone:630-865-6624
Mailing Address - Fax:414-259-7515
Practice Address - Street 1:201 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-259-7275
Practice Address - Fax:414-259-7515
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-015945225100000X
WI14912-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00471771Medicare PIN
IL216859003Medicare PIN
IL202845001Medicare PIN
IL202845158Medicare PIN
ILK41388Medicare PIN