Provider Demographics
NPI:1497138796
Name:WEATHERS, JAN L (PT;DPT)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:PT;DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-1104
Mailing Address - Country:US
Mailing Address - Phone:701-228-3743
Mailing Address - Fax:
Practice Address - Street 1:309 2ND ST E
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1104
Practice Address - Country:US
Practice Address - Phone:701-228-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-04
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist