Provider Demographics
NPI:1750122693
Name:JETER, COLEEN DODSON (PT)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:DODSON
Last Name:JETER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 CENTERVIEW DR STE 200-259
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3363
Mailing Address - Country:US
Mailing Address - Phone:770-283-7554
Mailing Address - Fax:
Practice Address - Street 1:1900 W ALPHA CT APT 211
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9198
Practice Address - Country:US
Practice Address - Phone:352-249-7128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist