Provider Demographics
NPI:1528188307
Name:OPHEIM, JEANNE D
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:D
Last Name:OPHEIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3405
Mailing Address - Country:US
Mailing Address - Phone:972-739-3097
Mailing Address - Fax:972-739-2673
Practice Address - Street 1:1645 N TOWN EAST BLVD
Practice Address - Street 2:SUITE 503
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4158
Practice Address - Country:US
Practice Address - Phone:972-686-3901
Practice Address - Fax:972-686-3985
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare UPIN