MEDICARE: JACELYN RAE DAWSON

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
1	225200000X	Physical Therapy Assistant	14-04210	KS

General Provider Information

NPI Number	:	1487491411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACELYN RAE DAWSON

Provider Business Mailing Address
First Line	:	219 LAUREL ST
Second Line	:
City	:	MINNEAPOLIS
State	:	KS
Zip	:	67467-2903
Country	:	US
Telephone Number	:	785-488-6131
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 E 8TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	KS
Zip	:	67467-1907
Country	:	US
Telephone Number	:	785-392-2122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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Directions to “ JACELYN RAE DAWSON ” Practice Location

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