MEDICARE: MICHELLE LADEBURG-JEANES MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	02403	IA

General Provider Information

NPI Number	:	1194078873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LADEBURG-JEANES MPT

Provider Business Mailing Address
First Line	:	709 W MAIN ST
Second Line	:	PO BOX 359
City	:	MANCHESTER
State	:	IA
Zip	:	52057-1526
Country	:	US
Telephone Number	:	563-927-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E MISSION ST
Second Line	:
City	:	STRAWBERRY POINT
State	:	IA
Zip	:	52076-0000
Country	:	US
Telephone Number	:	563-933-6277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	12/31/2014

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