Healthcare Provider Details

I. General information

NPI: 1194129056
Provider Name (Legal Business Name): JESSE ALEXANDER FRANK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 KANSAS ST
DOWNS KS
67437-1404
US

IV. Provider business mailing address

600 3RD ST APT 8
DOWNS KS
67437-2038
US

V. Phone/Fax

Practice location:
  • Phone: 785-454-3321
  • Fax:
Mailing address:
  • Phone: 785-346-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-04969
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: