Jessica Fohrman
Individual provider Active NPI Physical Therapy Assistant · Dover, MN
NPI 1679964282 · NPPES record last updated Feb 18, 2015
Key facts
- NPI
- 1679964282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- A369 (MN)
- Practice address
- 279 5TH Ave SE
Dover, MN 55929-1414 - Phone
- (507) 202-6476
- NPI assigned
- Feb 18, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A369 | MN | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A369 | MN | Yes |
Addresses
Primary practice location
279 5TH Ave SE
Dover, MN 55929-1414
Mailing address
279 5TH Ave SE
Dover, MN 55929-1414
Phone (507) 202-6476
Other providers in Dover, MN
All providers in Dover, MN · Physical Therapy Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.