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General NPI Number Information
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NPI Number | 1275647372
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Entity Type | Organization
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Legal Business Name | DANA JETER, P.T. L.L.C.
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 938 W MAIN ST SUITE 1
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City | HILLSBORO
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State | OH
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Zip | 45133-7484
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Country | US
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Telephone | 937-393-9272
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Fax | 937-393-9273
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Provider Business Mailing Address
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Address Line | 938 W MAIN ST SUITE 1
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City | HILLSBORO
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State | OH
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Zip | 45133-7484
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Country | US
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Telephone | 937-393-9272
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Fax | 937-393-9273
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MR. DANA P. JETER
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Credential | P.T.
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Telephone | 937-393-9272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT4493
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License Number State | OH
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