Provider Demographics
NPI:1295207140
Name:SENN, JEFFREY ETHAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ETHAN
Last Name:SENN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4555
Mailing Address - Country:US
Mailing Address - Phone:989-356-8004
Mailing Address - Fax:989-356-8034
Practice Address - Street 1:300 W DWIGHT ST
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-1406
Practice Address - Country:US
Practice Address - Phone:989-739-4617
Practice Address - Fax:989-739-4617
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009789261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy