Provider Demographics
NPI:1043739758
Name:JESHURUN, JENNIFER (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JESHURUN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:POHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23800 W 10 MILE RD STE 182
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3123
Mailing Address - Country:US
Mailing Address - Phone:248-763-3653
Mailing Address - Fax:
Practice Address - Street 1:23800 W 10 MILE RD STE 182
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3123
Practice Address - Country:US
Practice Address - Phone:248-962-3006
Practice Address - Fax:248-232-7328
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist