Provider Demographics
NPI:1922268325
Name:SWEETAPPLE, JEAN C (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:C
Last Name:SWEETAPPLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:C
Other - Last Name:COWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:301 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2861
Mailing Address - Country:US
Mailing Address - Phone:208-215-2210
Mailing Address - Fax:
Practice Address - Street 1:301 N 3RD ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2861
Practice Address - Country:US
Practice Address - Phone:208-215-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-2263OtherIDAHO STATE BOARD OF MEDICINE