Jessica L Bosquez, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10845-024 Issued in WI

Practice address

103 S Pioneer Rd
Fond Du Lac, WI 54935-3871

Phone

(920) 922-7776

NPI assigned

Jul 2, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Jessica L Grede Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471219200000",
    "number": "1962609800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S PIONEER RD",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S PIONEER RD",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353871",
            "telephone_number": "920-922-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSQUEZ",
        "first_name": "JESSICA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-02",
        "last_updated": "2016-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10845-024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "GREDE",
            "middle_name": "L",
            "prefix": "MRS.",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.