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General NPI Number Information
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NPI Number | 1124836663
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Entity Type | Individual
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Provider Name | JEANIE MARIE WIERTZEMA P.T.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 5206 W VILLAGE PKWY STE 6
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City | ROGERS
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State | AR
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Zip | 72758-8137
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Country | US
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Telephone | 479-936-2978
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Fax |
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Provider Business Mailing Address
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Address Line | 16025 HICKORY DR
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City | ROGERS
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State | AR
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Zip | 72756-6358
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Country | US
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Telephone | 417-844-2560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3945
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License Number State | AR
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