Provider Demographics
NPI:1225530561
Name:KORESKY, JENNIFER LYNN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:KORESKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 W BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:MORRICE
Mailing Address - State:MI
Mailing Address - Zip Code:48857-9711
Mailing Address - Country:US
Mailing Address - Phone:989-251-4587
Mailing Address - Fax:
Practice Address - Street 1:1288 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895
Practice Address - Country:US
Practice Address - Phone:517-655-1813
Practice Address - Fax:517-655-9626
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist