# JESSE L WIED PT PHYSICAL THERAPY CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wied Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538101902
- **Authorized official:** MRS. LAURA CAGE WIED (SECRETARY TREASURER)
- **Authorized official phone:** (318) 322-7050

## Contact information

- **Practice address:** 1901 ROSELAWN AVE SUITE A, MONROE, LA 71201
- **Practice address phone:** (318) 322-7050
- **Practice address fax:** (318) 322-7031
- **Mailing address:** PO BOX 14151, MONROE, LA 71207-4151
- **Mailing address phone:** (318) 322-7050
- **Mailing address fax:** (318) 322-7031

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 07/29/2015