Individual
LESA DEJONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10135 S BRANCH, SAINT JOHN, IN 46373-8415
(304) 542-6988
Mailing address
10135 S BRANCH, SAINT JOHN, IN 46373-8415
(304) 542-6988
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004455A
IN
225200000X
Physical Therapy Assistant
160006192
IL
Other
Enumeration date
05/08/2015
Last updated
05/08/2015
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