Provider Demographics
NPI:1346692373
Name:JEX, NICHOLAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:JEX
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6582 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2006
Mailing Address - Country:US
Mailing Address - Phone:810-334-1127
Mailing Address - Fax:
Practice Address - Street 1:87 N HOWARD AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1200
Practice Address - Country:US
Practice Address - Phone:810-334-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist