Basic Information
| Provider Information | |||||||||
| NPI: | 1619171006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PABIAN | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17701 212TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | FOXHOLM | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587189666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014685624 | ||||||||
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| Practice Location | |||||||||
| Address1: | 317 1ST AVE. NW | ||||||||
| Address2: | |||||||||
| City: | KENMARE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013854296 | ||||||||
| FaxNumber: | 7013854276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 892 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.