Provider Demographics
NPI:1194078873
Name:LADEBURG-JEANES, MICHELLE (MPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LADEBURG-JEANES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:JEANES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:709 W MAIN ST
Mailing Address - Street 2:PO BOX 359
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1526
Mailing Address - Country:US
Mailing Address - Phone:563-927-3232
Mailing Address - Fax:
Practice Address - Street 1:111 E MISSION ST
Practice Address - Street 2:
Practice Address - City:STRAWBERRY POINT
Practice Address - State:IA
Practice Address - Zip Code:52076-0000
Practice Address - Country:US
Practice Address - Phone:563-933-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist