Provider Demographics
NPI:1871750570
Name:VETTER, JENNIFER WIDELL (PT, OCS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WIDELL
Last Name:VETTER
Suffix:
Gender:F
Credentials:PT, OCS
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Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:426 S ALABAMA ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-3301
Practice Address - Country:US
Practice Address - Phone:317-528-6804
Practice Address - Fax:317-528-3781
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05014443A225100000X
OR3577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist