Provider Demographics
NPI:1417438730
Name:HARDENBURG, JAMIE DANIELLE (PTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DANIELLE
Last Name:HARDENBURG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DANIELLE
Other - Last Name:GEROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2671 MOUNT FOREST RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48613-9650
Mailing Address - Country:US
Mailing Address - Phone:989-313-1241
Mailing Address - Fax:
Practice Address - Street 1:2671 MOUNT FOREST RD
Practice Address - Street 2:
Practice Address - City:BENTLEY
Practice Address - State:MI
Practice Address - Zip Code:48613-9650
Practice Address - Country:US
Practice Address - Phone:989-903-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004015225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant