Provider Demographics
NPI:1235294885
Name:JAMROG, CATHERINE (PT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:JAMROG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 365
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-380-3550
Mailing Address - Fax:248-380-1620
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 365
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-380-3550
Practice Address - Fax:248-380-1620
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM77520005Medicare ID - Type Unspecified