Individual
JONATHAN DETTMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
11143 PARKVIEW PLAZA DR STE 100, FORT WAYNE, IN 46845-1728
(260) 266-7400
(260) 266-7439
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05012496A
IN
Other
Enumeration date
07/18/2017
Last updated
12/23/2020
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