Provider Demographics
NPI:1073953378
Name:KLEYN, MARY JO (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:KLEYN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:11301 COMMERCE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8200
Mailing Address - Country:US
Mailing Address - Phone:616-895-4770
Mailing Address - Fax:616-895-4774
Practice Address - Street 1:11301 COMMERCE DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8200
Practice Address - Country:US
Practice Address - Phone:616-895-4770
Practice Address - Fax:616-895-4774
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5502000356225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant