Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 5501016503 | MI |
NPI | 1093112716 |
---|---|
Provider Name | Jessica Nicole Makedonsky-Bartlett |
First Address | Flint, MI 48503-2190 |
Second Address | Flint, MI 48503-2190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2014 |
Last Update Date | 24/11/2014 |