Provider Demographics
NPI:1558460436
Name:DERON, JACQUELINE FRANCES (PT, MS)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:FRANCES
Last Name:DERON
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
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Mailing Address - Street 1:2215 FULLER RD
Mailing Address - Street 2:117B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2303
Mailing Address - Country:US
Mailing Address - Phone:734-769-7100
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:117-B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2335
Practice Address - Country:US
Practice Address - Phone:734-769-7100
Practice Address - Fax:734-213-6947
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501001061225100000X, 2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary