Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | L1710647 | MI |
NPI | 1003134511 |
---|---|
Provider Name | Deanne Jones |
First Address | Davison, MI 48423-3620 |
Second Address | Davison, MI 48423-3620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2010 |
Last Update Date | 07/05/2010 |