Provider Demographics
NPI:1326176751
Name:NESBITT, JANELLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:NESBITT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 VICTOR PATH UNIT 7
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4530
Mailing Address - Country:US
Mailing Address - Phone:651-330-2543
Mailing Address - Fax:
Practice Address - Street 1:1545 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:FALCON HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55113-6316
Practice Address - Country:US
Practice Address - Phone:651-487-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist