Individual
MR. JESSE LEE WIED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1815 ROSELAWN AVE, MONROE, LA 71201-5433
(318) 322-7050
(318) 322-7031
Mailing address
1815 ROSELAWN AVE, MONROE, LA 71201-5433
(318) 322-7050
(318) 322-7031
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02241R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1551813
—
LA
Enumeration date
09/30/2005
Last updated
10/25/2007
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