Provider Demographics
NPI:1568062016
Name:JEAKLE, MOLLY A (DPT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:JEAKLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MERCER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1146
Mailing Address - Country:US
Mailing Address - Phone:231-675-0668
Mailing Address - Fax:
Practice Address - Street 1:6510 M 66 N
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9272
Practice Address - Country:US
Practice Address - Phone:231-547-0380
Practice Address - Fax:231-547-0395
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist