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NPI Code Detail

MEDICARE: JEANNA DWYER PT

MEDICARE: JEANNA DWYER PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist8828MN

General Provider Information

NPI Number : 1114215183
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNA DWYER PT
Provider Business Mailing Address
First Line : 6625 LYNDALE AVE S STE 430
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-2300
Country : US
Telephone Number : 952-285-2840
Fax Number :
Provider Business Practice Location Address
First Line : 6625 LYNDALE AVE S STE 430
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-2300
Country : US
Telephone Number : 952-285-2840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2011
Last Update Date : 08/19/2024

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