Provider Demographics
NPI:1447574058
Name:JOYCE, JONAH DEAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JONAH
Middle Name:DEAN
Last Name:JOYCE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7274 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LAMOURE
Mailing Address - State:ND
Mailing Address - Zip Code:58458-9409
Mailing Address - Country:US
Mailing Address - Phone:701-883-5464
Mailing Address - Fax:
Practice Address - Street 1:1351 BROADWAY N
Practice Address - Street 2:201 S UNIVERSITY DR.
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2638
Practice Address - Country:US
Practice Address - Phone:701-277-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist