Provider Demographics
NPI:1033578315
Name:GREER, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:GREER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8273 GRAND RIVER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9346
Mailing Address - Country:US
Mailing Address - Phone:248-485-7042
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:8273 GRAND RIVER RD STE 210
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9346
Practice Address - Country:US
Practice Address - Phone:248-485-7042
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010004812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer