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NPI Code Detail

MEDICARE: JAN L WEATHERS PT;DPT

MEDICARE: JAN L WEATHERS PT;DPT
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
1225100000XPhysical Therapist1894ND

General Provider Information

NPI Number : 1497138796
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN L WEATHERS PT;DPT
Provider Business Mailing Address
First Line : 309 2ND ST E
Second Line :
City : BOTTINEAU
State : ND
Zip : 58318-1104
Country : US
Telephone Number : 701-228-3743
Fax Number :
Provider Business Practice Location Address
First Line : 309 2ND ST E
Second Line :
City : BOTTINEAU
State : ND
Zip : 58318-1104
Country : US
Telephone Number : 701-228-3743
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2015
Last Update Date : 09/19/2024

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