Provider Demographics
NPI:1073826038
Name:FLOWERS, JEREMY JOSEPH (LPTA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:JOSEPH
Last Name:FLOWERS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 MEISNER AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2434
Mailing Address - Country:US
Mailing Address - Phone:810-240-2551
Mailing Address - Fax:
Practice Address - Street 1:1235 S CENTER RD
Practice Address - Street 2:UNIT 12
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1700
Practice Address - Country:US
Practice Address - Phone:810-743-8820
Practice Address - Fax:810-743-5908
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002581225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant