Individual
MR. ALAN JAY DETTMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
102 DONOVAN DR, GRAND RAPIDS, MN 55744
(218) 259-2143
Mailing address
102 DONOVAN DR, GRAND RAPIDS, MN 55744
(218) 259-2143
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7152
MN
Other
Enumeration date
03/03/2006
Last updated
02/14/2014
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