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 1:1991 94TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MAXBASS
Mailing Address - State:ND
Mailing Address - Zip Code:58760-9722
Mailing Address - Country:US
Mailing Address - Phone:361-215-9914
Mailing Address - Fax:
Practice Address - Street 1:602 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MOHALL
Practice Address - State:ND
Practice Address - Zip Code:58761-4100
Practice Address - Country:US
Practice Address - Phone:701-756-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-04
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker