Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003455882 |
---|---|
Provider Name | Jena Jarvis |
First Address | Flat Rock, MI 48134-2764 |
Second Address | Flat Rock, MI 48134-2764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2019 |
Last Update Date | 27/12/2019 |