Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501007634 | MI |
NPI | 1720529340 |
---|---|
Provider Name | Jamie Haines |
First Address | Mt Pleasant, MI 48859-0001 |
Second Address | Mt Pleasant, MI 48859-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2017 |
Last Update Date | 15/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5501007634 | STATE LICENSE (01) | MI |