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General NPI Number Information
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NPI Number | 1750122693
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Entity Type | Individual
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Provider Name | COLEEN DODSON JETER PT
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1900 W ALPHA CT APT 211
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City | LECANTO
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State | FL
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Zip | 34461-9198
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Country | US
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Telephone | 352-249-7128
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Fax |
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Provider Business Mailing Address
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Address Line | 5540 CENTERVIEW DR STE 200-259
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City | RALEIGH
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State | NC
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Zip | 27606-3363
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Country | US
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Telephone | 770-283-7554
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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 |
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License Number State |
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