Provider Demographics
NPI:1275647372
Name:DANA JETER, P.T. L.L.C.
Entity Type:Organization
Organization Name:DANA JETER, P.T. L.L.C.
Other - Org Name:JETER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:937-393-9272
Mailing Address - Street 1:938 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7484
Mailing Address - Country:US
Mailing Address - Phone:937-393-9272
Mailing Address - Fax:937-393-9273
Practice Address - Street 1:938 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7484
Practice Address - Country:US
Practice Address - Phone:937-393-9272
Practice Address - Fax:937-393-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT4493261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2821683Medicaid
OH2821683Medicaid