Provider Demographics
NPI:1366581191
Name:JELINEK, DENISE RITA (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:RITA
Last Name:JELINEK
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 1:1391 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-5068
Mailing Address - Country:US
Mailing Address - Phone:701-642-1345
Mailing Address - Fax:
Practice Address - Street 1:2400 ST FRANCIS DR
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1025
Practice Address - Country:US
Practice Address - Phone:218-643-0345
Practice Address - Fax:218-643-0853
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6467225100000X
ND915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist