Individual
JEFFREY S HANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
607 DEMERS AVE - ALTRU CLINIC / EAST GRAND FORKS, EAST GRAND FORKS, MN 56721
(218) 773-0357
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
718
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25228
BLUE SHIELD
ND
Enumeration date
11/15/2006
Last updated
03/07/2019
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