Healthcare Provider Details

I. General information

NPI: 1629297684
Provider Name (Legal Business Name): LEE M WERCHAU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 STATE AVE SUITE B
DICKINSON ND
58601-4660
US

IV. Provider business mailing address

1110 FOSTER DR
DICKINSON ND
58601-4051
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-9400
  • Fax: 701-483-9398
Mailing address:
  • Phone: 701-483-9400
  • Fax: 701-483-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1237
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: