Provider Demographics
NPI:1235849662
Name:HUNTER, JERALYN JO (PT)
Entity Type:Individual
Prefix:
First Name:JERALYN
Middle Name:JO
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JERALYN
Other - Middle Name:JO
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:269 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9488
Mailing Address - Country:US
Mailing Address - Phone:616-403-8707
Mailing Address - Fax:
Practice Address - Street 1:3152 PEREGRINE DR NE STE 115
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9723
Practice Address - Country:US
Practice Address - Phone:616-643-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist