Provider Demographics
NPI:1063582286
Name:JEANSON, PAULETTE ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:ELIZABETH
Last Name:JEANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:ELIZABETH
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1305 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0401
Mailing Address - Country:US
Mailing Address - Phone:605-333-7188
Mailing Address - Fax:605-333-1585
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-333-7188
Practice Address - Fax:605-333-1585
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist