Provider Demographics
NPI:1477654887
Name:FUHRER, JESSE (MPT)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:FUHRER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13140 150TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAINT HILAIRE
Mailing Address - State:MN
Mailing Address - Zip Code:56754-9777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:414 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557-4912
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP53868OtherHEALTH PARTNERS
MN214P2FUOtherBCBS
MN6405708OtherMEDICA
MN214P2FUOtherBCBS